PMC3565151_01
Photographs of the patient's face. (A) The face showed marked swelling of right cheek and periorbital area involving eyelid, severe proptosis of the right eye. (B) Nine cardinal gaze photographs showed severe limitation of the right eyeball movement for all gazes except abduction.
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F1
The facial and periorbital swelling became more aggravated and the patient was referred to our hospital (Fig. 1A). In the examination of eyeball movement, his right eye had shown severe limitation of movement in all directions (Fig. 1B).
CT findings of the patient. (A) Coronal CT scan at presentation showed severe maxillary and ethmoidal sinusitis as well as marked inflammatory swelling of soft tissue in the right cheek and temporal region. Intraorbital soft tissue inflammation and thickening of the lateral rectus muscle of right eye were also observed. (B) Axial CT scan taken 1 day after sinus surgery showed severe tenting of the posterior part of globe (arrow) and stretching of the optic nerve due to severe proptosis.
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F2
Also, findings of severe inflammation in orbital soft tissue and extraocular muscles, which is correspond with the findings of orbital cellulitis, were observed (Fig. 2A). Severe proptosis and deformation of the posterior pole of the right eye into a cone shape by severe stretching of the optic nerve were found in the orbital CT (Fig. 2B).
Fundus findings of the patient. (A) Fundus photograph of the right eye showed a pale optic disc, cherry red spot in macula, and edema at the posterior pole. (B) Fluorescein angiography of right eye showed a delay of retinal circulation.
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F3
Pale optic disc, cherry red spot in the fovea and retinal edema were found from the fundus examination (Fig. 3A). In fluorescein angiography, delay of retinal circulation was observed (Fig. 3B).
Swelling of the cheek and proptosis of the right eye had nearly subsided after 2 weeks of hospitalization but visual loss had not been recovered.
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F4
After 12 days of hospitalization, proptosis, limitation of eyeball movement, and afferent pupillary defect had been resolved, but the visual loss had not recovered at all (Fig. 4).