Ophthalmological strategy in maxillary sinus atelectasis

Relevance One of the causes of progressive displacement of the eyeball into the orbit is atelectasis of the maxillary sinus (MS), which often occurs against the background of subclinical sinusitis. Traditionally, a two-stage approach is used to treat this disease: functional endoscopic sinusotomy (FES), and then orbitoplasty. Some authors believe that this method is preferable to a one-stage operation, since it reduces the risk of infectious complications and can lead to regression of enophthalmos and hypophthalmos after FES. Objective To analyze the results of treatment of patients with atelectasis of the MS using a two-stage treatment tactic. Material and methods From 2011 to 2024, 18 patients (18 eyes) diagnosed with atelectasis of the MS were examined at the Krasnov Research Institute of Eye Diseases. All patients underwent exophthalmometry according to Hertel, measurement of the parameters of the palpebral fissure, assessment of the binocular status and photo registration, as well as CT of the paranasal sinuses in dynamics. Results The average age of patients was 34 years (range from 24 to 48 years), among them there were 2 men and 16 women. After the FES stage, 12 patients underwent transconjunctival orbitoplasty with the placement of an alloplant for orbitoplasty. In two cases, non-surgical correction of enophthalmos was performed using the previously proposed technique of intraorbital injection of a hyaluronic acid filler [1, 2]. As a result of the treatment, a reliably significant decrease in enophthalmos, hypophthalmos and lagophthalmos, as well as an increase in the excursion of the upper eyelid, were recorded. Improvement in the condition of the cornea, eyeball mobility and regression of diplopia were observed. Complications during the treatment were not registered. The average follow-up period was 28 months (from 6 to 144 months). The effect of injection tactics was comparable to surgical and remained stable longer than the period stated by the filler manufacturer, which is probably associated with the peculiarities of biodegradation in the orbit [3, 4]. Conclusion Treatment of patients with maxillary sinus atelectasis requires a multidisciplinary approach. A two-stage approach allowed achieving positive results with both surgical and non-surgical treatment tactics. In the case of injection correction techniques, one should not forget about the risks of vascular complications registered in the literature [5]. Keywords: maxillary sinus atelectasis; silent sinus syndrome; enophthalmos; hypophthalmos; fillers; hyaluronic acid