J.ophthalmol.(Ukraine).2022;1:37-43.
http://doi.org/10.31288/oftalmolzh202213743
Received: 11 August 2021; Published on-line: 15 March 2022
Computed tomography evidence of the state of the paranasal sinuses in patients with uncomplicated anterior uveitis versus anterior uveitis complicated by optic neuritis
L. V. Venger 1, O. V. Kovtun 1, V. V. Savko 2
1 Odesa National Medical University; Odesa (Ukraine)
2 SI "The Filatov Institute of Eye Diseases and Tissue Therapyof the NAMS of Ukraine"; Odesa (Ukraine)
E-mail: kvnkonovalova@gmail.com
TO CITE THIS ARTICLE: Venger L.V., Kovtun O.V., Savko V.V. Computed tomography evidence of the state of the paranasal sinuses in patients with uncomplicated anterior uveitis versus anterior uveitis complicated by optic neuritis. J.ophthalmol.(Ukraine).2022;1:37-43. http://doi.org/10.31288/oftalmolzh202213743
Background: It is clinically important to review the state of patient’s paranasal sinuses, because a paranasal sinus disease creates the conditions for the onset of infection and its spread to the eyes and nose. This is especially important given a significant rise in the incidence of ocular inflammatory disease in recent years.
Purpose: To identify computed tomography (CT) features of the paranasal sinuses in patients with idiopathic anterior uveitis.
Material and Methods: One hundred and fifty patients with unilateral idiopathic anterior uveitis were involved in the study. Of these, 114 did not have signs of optic neuritis, and 36 had optic neuritis in the presence of uveitis. Patients underwent a routine eye examination (best-corrected visual acuity, ophthalmoscopy, biomicroscopy, intraocular pressure measurement, and Humphrey perimetry). Sinus CT scans were performed on a Philips Brilliance 16-slice scanner. Patients received treatment as per the Protocol for the Diagnosis and Treatment of Anterior Uveitis.
Results: On the basis of CT reports, we identified CT features of the paranasal sinuses in patients with idiopathic anterior uveitis complicated by optic neuritis. There was CT evidence of maxillary sinus mucosal thickening and cerebrospinal fluid space expansion in all patients (n=36) with anterior uveitis complicated by optic neuritis. Fluid accumulation in the maxillary, frontal, and sphenoid sinuses was diagnosed in 41.7%, 11.1%, and 5.6%, respectively, of patients with anterior uveitis complicated by optic neuritis, which was significantly higher, than in patients with uncomplicated anterior uveitis. We found a significant and strong positive correlation of (a) maxillary sinus mucosal thickening with fluid accumulation in the maxillary sinus and cerebrospinal fluid space expansion and (b) decreased frontal sinus pneumatization and fluid accumulation in the frontal sinus.
Conclusion: Sinus CT data enabled to find a significant association between the pattern of changes in the paranasal sinuses and the development of optic uveitis in patients with idiopathic anterior uveitis, which, generally, argues for performing sanitation of the sinuses when treating ocular inflammation.
Keywords: idiopathic anterior uveitis, optic neuritis, paranasal sinuses, computed tomography
References
1.Panchenko MV, Samofalova MN, Honchar ON, Lytvyshchenko AV, Friantseva MV. [Retinal nerve fiber layer thinning in uveitis complicated by optic nerve inflammation]. Arkhiv oftalmologii Ukrainy. 2016;4(1):50-3. Russian.
2.Gupta A, Gupta V, Herbort CP, Khairallah M, editors. Uveitis Text and Imaging. New Delhi: Jaypee Brothers Medical Publishers; 2009.
3.Nussenblatt RB, Whitcup SM, editors. Uveitis: fundamental and clinical practice. 4th ed. Mosby; St. Louis: 2012.
4.Tubulointerstitial nephritis and uveitis (TINU) syndrome: a systematic review of its epidemiology, demographics and risk factors. Orphanet J Rare Dis. 2017; 12(1):128.
5.Venger LV, Savko VV, Kovtun OV, Sokolov VM. Clinical features of the course of optic neuritis as a complication of idiopathic anterior uveitis. J.Ophthalmol.(Ukraine). 2021;(5):41-7.
6.Foster CS, Vitale AT, editors. Diagnosis and Treatment of Uveitis. 2nd ed. New Delhi: Jaypee Brothers; 2013.
7.Venger LV, Kovtun OV, Savko VV. [Relationship between the size of the ethmoid sinus and the possibility of developing optic neuritis in patients with idiopathic anterior iridocyclitis]. In: [Proceedings of the national Conference on Current Issues in Ophthalmology]. Mykolaiv, September 22-23, 2021. p. 33-5. Ukrainian.
8.Panfilova GV, Shpak NN. [Value of the sphenoid sinus size in the development of optic nerve disease]. Oftalmol Zh. 1993:185-8. Russian.
9.Zolotareva MM. [Ocular symptoms in diseases of the eye, nose, throat and oral cavity]. Minsk: Belarus; 1969. Russian.
10.Garashchenko TE, Kitaigorodskii AP. [Diagnosis and treatment of orbital complications of acute and chronic sinusitis in children]. Rossiiskaia rinologiia. 1996;(2-3):74-6. Russian.
11.Zelentsov KS, Ioileva EE, Zelentsov SN. [Ultrasound assesment of optic disc size in patients with ocular contusion]. Tochka Zreniya. Vostok – Zapad. 2017; (3):78-80. Russian.
12.Semenov AV, Monakov NV, Balkhanova EI, Raznobarskii AA, Mamonova TA. [Multislice computed tomography in the diagnosis of mixed traumatic brain injury]. Vestnik rentgenologii i radiologii. 2018;99(3):119-124. Russian.
13.Jabs DA, Nussenblatt RB, Rosenbaum JT. Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005 Sep; 140(3):509 -16.
14.Beck RW, Cleary PA, Anderson MM et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992; 326(9): 581–88.
15.Nakagawa H, Noma H, Kotake O, Motohashi R, Yasuda K, Shimura M. Optic neuritis and acute anterior uveitis associated with influenza A infection: a case report. Int Med Case Rep J. 2017;(10):1–5.
16.Glantz S. [Primer of biostatistics]. Moscow: Praktika; 1998. Russian.
17.Panfilova GV, Shitova IIa. [X-ray studies in ophthalmology]. Kyiv: Zdorov’ia. 1980. Russian.
18.Al-Abri R, Bhargava D, Al-Bassam W, Al-Badaai Y, Sawhney S. Clinically significant anatomical variants of the paranasal sinuses. Oman Med J. 2014; 29: 110–13.
19.Albalwi Y, Alroqi A, Alharethy S. Anatomical variations in Computerized Tomography of paranasal sinuses in a Saudi population. Saudi J Otolaryngol Head Neck Surg. 2019;21:1–5.
20.Berhouma M, Jacquesson T, Abouaf L, Vighetto A, Jouanneau E. Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature. Neurosurg Focus. 2014; 37(4):E19.
21.Girguis-Bucher A, Schlegel-Wagner C. Anatomical variation of the extracranial course of the optic nerve in the floor of the sphenoid sinus: first reported case. J Laryngol Otol. 2013 Aug;127(8):822-4.
Conflict of Interest Statement: The authors declare no conflict of interest.
Source of Funding: There are no external sources of funding.