Paraocular sinus mucoceles

Patients with paraocular sinus masses may manifest ocular complications, including orbital displacement, proptosis, diplopia, restricted extraocular muscles, decreased vision, chemosis, pain, and optic neuritis.

Two patients with paraocular sinus masses came to our clinic for examination. One had proptosis and orbital displacement and a chief symptom of increasing diplopia, along with dull brow pain and sudden decreased vision of the left eye. He was diagnosed with polypoid disease and mucoceles of the ethmoidal and frontal sinuses. The second patient experienced pain and swelling under his left eye. He had an upper respiratory tract infection with sinusitis, which in turn increased the size of the sinus cyst.

Computed tomography (CT) of the sinuses and orbits was ordered for both patients and confirmed the presence of mucoceles in each case. The first patient's signs and symptoms decreased over 2 weeks, so surgical intervention at that time was not necessary. The second patient was treated with 60-mg pseudoephedrine q.i.d. and 250-mg amoxicillin/potassium clavulanate q.i.d.

Mucoceles are slow-growing polyp-like cysts of the sinuses; these cysts may be sterile in composition or harbor purulent infection (mucopyocele). In either case; they are space-occupying lesions that increase in size as mucus secretions continue, and can be exacerbated by active sinusitis. Differential diagnosis includes thyroid eye disease, orbital pseudotumor, infection, trauma, benign or malignant tumors, encephalocele, or meningiocele.