Authors: Dr Nilanka Mudithakumara , Dr Viraj Jayasinghe

Abstract

Introduction

Unilateral ptosis could be the initial presentation of a disease with dreaded complications including neurological conditions, ophthalmological and mechanical causes, tumors, etc. Acute sinusitis may present with facial pain with mild swelling and catarrhal features. Ipsilateral ptosis with sinusitis could be due to a complication of sinusitis, indicating orbital or cavernous sinus involvement. We present a case of a 13 year old Sri Lankan boy presenting with unilateral ptosis with one weekof nasal congestion, diagnosed with left frontal sinusitis complicated with right eye ptosis without other evidence of neurological orinfectious pathologies or a trauma history.

Case Report

A 13 -year-old boy was presented to the emergency department with leftsideddrooping eye lid and chronic ipsilateral headache and seven days history of nasal congestion. He had no fever or other features to suggest infection, trauma or toxin exposure.  He was not appearing ill looking , no photophobia, no neck-stiffness. On examination, he had left sided partial ptosis of the left eye without diplopia or pupillary changes or other types of ophthalmoplegia without any other neurological signs.

Magnetic Resonance Imaging showed no brain  pathology or cavernous sinus thrombosis. There were features of left frontal sinusitis with mucosal thickening. The full blood count, inflammatory markers and the septic screening was negative. The lumbar puncture and the blood culture did not reveal any neurological infection or speticaemia. Initially started empirical intravenous antibiotics (Ceftriaxone) were scaled down to oral Co-amoxiclav, nasal decongestions and simple anaelgesics, and the ptosis drastically improved within days.

Conclusion

Acute ptosis in a previously healthy child raises concerns of  a serious underlying pathology. Initially life-threatening and severely complicated differential diagnoses exclusion to be done. However, simple diseases like acute sinusitis also could present with alarming signs like unilateral pstosis.

Keywords: Acute Sinusitis/ ptosis