(BMJ)—A previously healthy 33-yo woman presented w/ sudden-onset drooping of her L upper eyelid and a sensation of the L eye having “dropped down.” Meds: none. Review of sx: negative. Exam: vital signs WNL; extraocular muscles intact; both upper lid margins in same position w/ respect to iris and corneal light reflex. CT confirmed dx. What is it?
Left partial 3rd-nerve palsy
Left Horner syndrome
Right thyroid eye dz
Left silent sinus syndrome
Left Hand-Schüller-Christian dz
You are correct. The image shows the hypoglobus and enophthalmos of the L eye, best appreciated when observed from below. In the absence of trauma, silent sinus syndrome is the most likely dx, which was confirmed by CT. Silent sinus syndrome occurs in pts w/ no hx of preceding sinusitis sx; hence, “silent.” The mechanism is complex obstruction of the maxillary sinus, resulting in hypoventilation, a negative pressure, and collapse of the orbital floor. The onset can be sudden and alarming. These pts should be referred to maxillofacial or ENT surgery for orbital floor repair and re-establishment of sinus aeration.

Emergency Medicine Journal 2019;36:505-510
By vgreene, 6 November, 2019

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