Paranasal sinus inflammation and non-specific orbital inflammatory syndrome: An uncommon association

Objectives: The aim of this study is to present a series of patients with orbital inflammatory symptoms associated with significant paranasal sinus inflammation, and to discuss the diagnostic and management modalities. Methods: A retrospective, non-comparative, interventional case series of all patients diagnosed with orbital inflammatory syndrome and significant sinus inflammation, seen at two Orbital Units between January 1999 and October 2005. The clinical records of all patients were reviewed. Results: Of 91 cases diagnosed with non-specific orbital inflammatory syndrome, six (6.6%, four males, two females mean age 51±17 years) had significant sinus inflammation. Symptoms and signs were periorbital swelling and erythema, proptosis, globe displacement and ocular motility restrictions with diplopia. On imaging, there was extraocular muscle enlargement and/or orbital fat haziness, as well as almost complete ipsilateral maxillary sinus opacification with varying degrees of opacification of adjacent sinuses. Sinus biopsy in four cases showed a non-specific inflammatory reaction. Treatment with steroids alone (four cases) or a combination of oral antibiotics and systemic steroids (two cases) resulted in resolution of signs and symptoms within 24-72 h. One case of recurrence was noted during a mean follow-up period of 9 months (range, 3-24 months), and this responded well to oral steroids. Conclusion: Although uncommon, paranasal sinusitis can be associated with a non-specific orbital inflammatory syndrome. When an infectious etiology is excluded, systemic steroids may play a major role in the management of these patients and result in prompt resolution of orbital signs and symptoms.