Ophthalmic Manifestations of PNS Disease: A Grading System

Abstract

Objective: The most currently used grading system for the orbital inflammatory complications secondary to sinusitis (Chandler classifications) does not cover the most common ophthalmic manifestations of the paranasal sinus diseases, allergic fungal sinusitis and chronic paranasal sinus disease. We propose a clinical grading system that encompasses (inflammatory and non-inflammatory).

Method: Thirty patients with ophthalmic manifestations due to paranasal sinus disease were graded according to the following: anatomic disturbance like proptosis (grade I); mild functional involvement in the form of epiphora, ophthalmoplegia, diplopia, ptoses (grade II); orbital infection (grade III); and visual impairment with or without orbital infection (grade IV).

Results: The ages ranged from 8 to 65 years with a mean of 30 years. Fifteen patients had orbital proptosis (grade I); 10 bilateral and 5 unilateral. Eleven patients had mild functional disturbance (grade II); 5 had epiphora, 3 had diplopia, and 2 had ptosis. Eight patients had orbital infection (grade III), and 5 patients had a visual loss (grade IV); 2 with orbital infection and 3 with mucocele and allergic fungal sinusitis. The main cause of the ophthalmic manifestation is allergic fungal sinusitis followed by chronic rhinosinusitis. The urgency of the surgical intervention is proportional to the grade degree.

Conclusion: This clinical grading system categorizes the ophthalmic manifestations due to paranasal sinus diseases; inflammatory and non-inflammatory pathology. The higher the grade of ophthalmic involvement the more urgent the need of surgical intervention. Allergic fungal sinusitis is the most common cause followed by chronic rhinosinusitis, with a ratio of 2:1.