Acute severe irreversible visual loss with sphenoethmoiditis-'posterior' orbital cellulitis
M. L. Slavin and J. S. Glaser
Orbital cellulitis secondary to adjacent paranasal sinusitis presents with
marked proptosis, ophthalmoplegia, eyelid edema, chemosis, and/or
conjunctival hyperemia. These conditions often precede visual dysfunction.
"Posterior" orbital cellulitis secondary to sphenoethmoidal sinusitis may
be defined as the clinical syndrome in which early severe visual loss
overshadows or precedes accompanying inflammatory orbital signs. The visual
loss may be attributed to involvement of the intracanalicular or orbital
apical segment of the optic nerve. Total irreversible unilateral visual
loss developed in three patients with this syndrome. Severe visual loss was
preceded by diplopia in one patient and by bilateral eyelid edema in
another. One patient with chronic panparanasal sinusitis with acute visual
loss presented with isolated optic disc edema. Proptosis and ductional
restriction subsequently developed. The irreversible blindness in these
cases may be due to a combination of intracanalicular edema and vasculitis
causing optic nerve infarction.
