A 34-year-old man notices gradual sinking of his right eye with a deepened upper eyelid crease and upward tilt of the eye over several months. There is no diplopia or vision loss. CT shows a completely opacified, small right maxillary sinus with downward bowing of the orbital floor and lateral retraction of the uncinate process. The most likely diagnosis is:
- A Silent sinus syndrome ✓
- B Maxillary sinus mucocele
- C Blow-out fracture of the orbital floor
- D Chronic invasive fungal sinusitis
Explanation
Silent sinus syndrome, or chronic maxillary sinus atelectasis, results from occult ostiomeatal complex obstruction creating negative pressure within the maxillary sinus, which gradually collapses inward, bowing the orbital floor downward and retracting the uncinate laterally. This produces painless enophthalmos and hypoglobus. A mucocele expands and causes proptosis, the opposite direction of globe displacement. Blow-out fracture gives an acute history with restricted upgaze, and invasive fungal disease occurs in immunocompromised patients with rapid tissue destruction.
Reference: Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.