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Clinical Problem Solving: Radiology
January 2007

Radiology Quiz Case 2: Diagnosis

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2007;133(1):93. doi:10.1001/archotol.133.1.93

The intraoperative and pathologic findings demonstrated that the patient had nasal polyps that had eroded the lamina papyracea and occupied part of the orbit. Spontaneous complications such as subperiosteal and orbital cellulitis and abscess, cavernous sinus thrombosis, osteomyelitis, lacrimal gland abscess, loss of vision, and eyeball displacement1 are rarely seen in nasal polyposis.2,3 Few cases of optic nerve affection have been reported,3 and only a small percentage involve total blindness.2 Most of the mechanisms that are responsible for optical neuritis associated with nasal disease are still unclear,4,5 but several causes have been proposed: (1) mechanical pressure over the optic nerve and the central artery of the retina2,4,5; (2) direct spread of infection to the nerve2,4,5; (3) indirect spread of infection through venous and lymphatic channels4,5; (4) hematogenous transference of infection4,5; and (5) localized allergic reaction involving the tissues of both sinus and orbit.2,4,5 Optical neuritis is thought to be attributable to a combination of these factors.1

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