Dr. GUPTA ROSHMI

Dr. SUSHMA A., Dr.Bhanumathi

Abstract

Case report: A 63 year-old male patient presented with a complaint of vertical binocular diplopia for 4 years. Ocular motility and prism bar cover tests were suggestive of right double elevator palsy. On examination, the right eye showed enophthalmos, hypoglobus and increased lid show. Magnetic resonance imaging of the orbit showed increased right orbital volume, imploding right maxillary sinus and increased concavity of the orbital floor. The relative positions of the extraocular muscles in the right orbit were not symmetrical with those on the left side. The diagnosis was of right silent sinus syndrome mimicking double elevator palsy.

Conclusion: A facial inspection with respect to symmetry was able to identify silent sinus syndrome, an unusual cause of vertical diplopia. Orbital imaging could confirm the diagnosis.