Clinical manifestations and management of orbital mucoceles: the role of ophthalmologists.

PURPOSE

To report the clinical features of orbital mucoceles and discuss the role of ophthalmologists in the management of patients with orbital mucoceles.

METHODS

A retrospective chart review was performed of all patients with orbital mucoceles treated at the National Taiwan University Hospital from 1990 through 2002. The basic profiles, clinical features, and the management of the patients with orbital mucoceles were recorded and analyzed.

RESULTS

The records of a total of 15 patients (aged 22 to 76, mean 45.5 years) with orbital mucoceles were selected for this study. The initial presentations included proptosis in ten patients (66.7%), diplopia in five (33.3%), ocular movement limitation in four (26.7%), periorbital pain in four (26.7%), palpable mass lesion in four (26.7%), ptosis in three (20.0%), decreased visual acuity in three (20.0%), headache in two (13.3%), and pupil abnormality with relative afferent papillary defect in one (6.67%). Of the 15 patients, the origins of the orbital mucocele were in the frontoethmoidal sinus in six (40.0%), the ethmoidal sinus in three (20.0%), the frontal sinus in three (20.0%), the maxillary sinus in one (6.7%), and the sphenoidal sinus in two (13.3%). The transcaruncular approach for the management of orbital mucoceles was performed in eight cases, the Lynch approach in three cases, the transforniceal approach in two cases, and functional endoscopic sinus surgery in one case. After surgery, no recurrence was noted.

CONCLUSIONS

The frontoethmoidal sinus was the commonest origin of an orbital mucocele, and proptosis was the most frequent sign in patients with an orbital mucocele. All cases showed a favorable response to surgical intervention, and the transcaruncular approach may offer a good surgical option for the management of orbital mucoceles, especially for ophthalmologists.