Endocrine Abstracts

Frequently seen in connection with thyroid disease, exophtalmic syndrome has a much large spectrum of differential diagnosis including numerous local and general aetiologies. Conditions such as mucoceles of paranasal sinuses don’t have always nasal or sinus symptoms but may present with ophthalmological manifestations.

A 50-year-old woman presented for a 2-months history of right eye proptosis with upper eyelid swelling, periorbital pain, occasionally diplopia, general sweating, and 5 kg weight loss. She didn’t report fever. Medical history included hypertension, dyslipidemia, and 3rd degree obesity. Physical examination revealed asymmetrical exophthalmia (Reye 22 mm and Leye 18 mm), chemosis, periorbital tissues swelling, especially of the upper eyelid, decreased ocular mobility, and diplopia on downward gaze. Intraocular pressure was 22 mmHg for the Reye and 16 mmHg for the Leye. Fundoscopic examination was normal. The thyroid function was normal. TRAbs were borderline (1.6 U/l) while TPOAbs were positive (163 U/l). Her white blood cell count was normal (8.01×10³/mm³) but sedimentation rate was slightly elevated (26.9 mm/h). Cranial CT scan showed asymmetrical exophthalmia (Reye 22.9 mm and Leye 19.2 mm) and an extensive cystic lesion, 35/18 per 30 mm diameter, originating in the frontal sinus with extension in the upper extremity of the right orbit, exerting mass effect on the superior oblique muscle, the medial rectus, and the right lacrimal gland. She developed acute inflammation (despite lack of systemic involvement) of the right orbital content (cellulites) which triggered rapid admission in ENT department. During surgery, acute sinusitis of the right maxillary, sphenoidal, ethmoidal, and frontal sinuses was observed. Treatment included surgical drainage under general anaesthesia with good post-operative recovery and minimal residual swelling.

In a patient with exophtalmic syndrome, rare causes such as sinus mucocele should be considered. Early recognition and treatment are very important in preventing orbital complications and avoid visual loss.