Ophthalmic Manifestations in ENT Diseases & Surgical Procedures

Objective: A prospective study was conducted in the department of ENT to see the incidence, Prevalence, Symptoms, signs and etiopathogenesis in relation to ophthalmic manifestations in ENT diseases and various ENT surgical procedures (iatrogenic). Material and methods: 35 cases were selected from IN and OUT patients of the department between July 1st 2008 to June 30th of 2009. 26 cases of orbital complications were due to various ENT diseases and 9 cases were of ENT surgical procedures with orbital complications. The standard otolaryngological and ophthalmological examination was carried out and thereafter proper hematological, radiological and histopathological examinations were done. After reaching the diagnosis, proper management was carried out. Result :35 cases of orbital complications were reported in ENT Department. Out of which, 29 cases were due to various ENT diseases and 6 cases were iatrogenic, caused by various ENT surgical procedures. Commonest ENT disease responsible for orbital complication is sinonasal tumours. Carcinoma maxilla was the most common tumour responsible for the orbital complications. Sinonasal tumours involving eye were found in wide age group range of 11 to 75 years, with higher incidence in males. Incidence of sinusitis complicating orbit is decreasing. Variety of ENT surgical procedures can involve orbital . Total maxillectomy has higher incidence of orbital complications. Conclusion: A variety of ENT diseases & surgical procedures can present with orbital complications due to anatomical association of orbit with the surrounding head and neck structures. Orbital involvement must be ruled out whenever an ENT patient presents with orbital complaints .Rapid diagnosis and treatment is necessary for preserving vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the appropriate management of such lesions. I. Material And Methods The present prospective study was carried out in Department of otorhinolaryngology of N.S.C.B. Medical College, Jabalpur during period of July 1st 2008 to June 30th 2009, and comprised of 35 cases. The cases were selected from IN and OUT patients Of the Department, who had orbital complications due to various ENT diseases and ENT surgical procedures. The patient was made comfortable and a detailed history of his /her complaints was taken under the various heading mentioned in the proforma. The standard procedure of otolaryngological and ophthalmic examination was carried out on each patient. Initial clinical examination of orbit was done in ENT department then referred to ophthalmology for further assessment. Beside routine hematological investigations, thyroid function test, radiological investigations like x ray skull, PNS, orbit, CT SCAN of head and neck, FNAC and biopsy for histopathology were done. After making diagnosis the proper management was done. II. Result Etiopathogenesis Total, 35 cases of orbital complications were reported in ENT Department. Out of which, 29 cases were due to various ENT diseases and 6 cases were iatrogenic, caused by various ENT surgical procedures. Commonest ENT disease responsible for orbital complications was various sinonasal tumors, comprising 19 cases, in which Ca maxilla constituted 7 cases, angiofibroma 3 cases, sinonasal inverted papilloma and lymphoma 2 cases each, Olfactory neuroblastoma,midline granuloma,and rhinosporodiosis 1 case each. Fungal Sinonasal infections constituted 2 cases, Bacterial Sinonasal infections constituted 1 case. Atrophic rhinitis with nasal myasis constituted one case, Facial palsies due to various reasons constitued 4 cases. Grave disease constituted 2 cases and Iatrogenic cases were 6 in number. Ophthalmic Manifestations In Ent Disesases & Surgical Procedures www.iosrjournals.org 88 | Page Table A. Incidence of orbital complications due to various ENT diseases And procedures. Table B. Sinonasal tumours with orbital complications III. Age Distribution Orbital complications due to various ENT diseases were is found in age group of 11-75 years. Orbital involvement in sinonasal tumours was seen in age group range of 11-75 year. The youngest patient was of fibrous dysplasia and oldest patient was of carcinoma maxilla. Orbital involvement in ca maxilla was found in age group of 35-75 years. Inverted papilloma was found in age group of 40-45 years. Fibrous dysplasia involved orbit in age group of 11-35 years .Orbital pathology due to fungal sinonasal infection was found in age group of 60-65 years. Graves disease involved orbit in age group of 20-50 years. Various ENT diseases causing orbital symptoms secondarily due to facial palsies were found in age group of 22-55 years. Iatrogenic causes responsible for orbital pathology were found in age group of 13-75 years. Table C. Age incidence in study group. IV. Sex Distribution Among total cases (ENT diseases + Iatrogenic), male cases were more than female cases comprising 19 males to 16 females. The patients where orbital pathology was due to ENT diseases, Male –female ratio was 16:9. Sex incidence in sinonasal tumors was 9: 6 (male: female). There was 4: 3 male –female ratio in carcinoma maxilla. Inverted papillomas and sinonasal lymphomas with orbital complications were present exclusively in males (2: 0). Fibrous dysplasia and graves disease had equal incidence in males and females (1: 1). Sinonasal infections were found in males only (3: 0). Iatrogenic orbital complications had males and females ratio of 6:3. Table D. Sex Incidence in study group. Etiology Male female Total cases 19 16 ENT diseases 16 9 Sinonasal tumours 9 6 Carcinoma maxilla 4 3 Inverted papillomas 2 0 sinonasal lymphomas 2 0 Sinonasal infections 3 0 Iatrogenic 6 3 Etiopathogenesis No of cases Sinonasal tumours 19 Sinonasal infection 3 Atrophic rhinitis with myasis 1