Letters to the Editor

Case Report

Recurrent Diplopia After Consuming Alcoholic Beverages



FREE PREVIEW Log in or buy this issue to read the full article. AAFP members and paid subscribers get free access to all articles. Subscribe now.


FREE PREVIEW Subscribe or buy this issue. AAFP members and paid subscribers get free access to all articles.

Am Fam Physician. 2004 Jul 1;70(1):31-32.

to the editor: A 67-year-old night watchman was referred to our clinic by an ophthalmologist because of a one-month history of recurrent vertical diplopia. The diplopia usually occurred after work when he was exhausted or after he had consumed sake. The diplopia always resolved spontaneously after sleeping, but this time it persisted for several weeks, and he finally consulted an ophthalmologist.

On examination, his right eye was higher than the left, which produced the vertical diplopia, but there was no facial swelling (Figure 1). Three-dimensional computed tomography showed a complete bone defect in the orbital floor and a mucocele (red) displacing the eyeball (blue) superiorly (Figure 2), which resulted in the symptom of vertical diplopia. Despite the defect in his orbital floor, the periosteum was intact. The mucocele was drained by aspiration (needle aspiration) through the gingivobuccal sulcus. After removing 20 mL of mucus, the right eye returned to the same level as the left eye, and the diplopia resolved completely. The aspirated mucus had no bacterial infection and the cytologic study showed no malignancy.

A Caldwell-Luc surgical technique had been performed on this patient for right maxillary sinusitis 30 years earlier, but the nasoantral window for drainage had gradually narrowed. The mucosal lining of the sinus continued to produce mucus, and it became swollen during and after inflammation (consuming alcohol) and pushed the eyeball superiorly. The diagnosis was postoperative maxillary sinus mucocele.

Figure 1

Patient with vertical diplopia (right eye higher than the left).

View Large


Figure 1

Patient with vertical diplopia (right eye higher than the left).


Figure 1

Patient with vertical diplopia (right eye higher than the left).

Figure 2

Three-dimensional computed tomography showing a complete bone defect in the orbital floor and a mucocele (red) displacing the eyeball (blue) superiorly.

View Large


Figure 2

Three-dimensional computed tomography showing a complete bone defect in the orbital floor and a mucocele (red) displacing the eyeball (blue) superiorly.


Figure 2

Three-dimensional computed tomography showing a complete bone defect in the orbital floor and a mucocele (red) displacing the eyeball (blue) superiorly.

Postoperative maxillary sinus mucocele is rare in the United states and Europe13 ; however, it is common in Japan.4.5 It typically occurs 10 to 15 years after the initial Caldwell-Luc operation and is accompanied by a swollen and painful cheek.5 Interestingly, this patient had never complained of a swollen and painful cheek. Even without those symptoms, recurrent diplopia would occur. The history of sinus surgeries is important to detect in such cases.

Currently, we are planning to reoperate on the right maxillary sinus to provide permanent drainage by an endoscopic sinus surgery. However, the patient’s liver function does not permit use of general anesthesia, because of chronic hepatitis.

KOICHI TSUNODA, M.D.

NAOMI AMAGAI, M.D.

MASANOBU HOUSUI, M.D.

KENJI KONDOU, M.D.

KENICHIROU ISHIO, M.D.

NAONOBU TAKEUCHI, M.D.

KIMITAKA KAGA, M.D.

Department of Otolaryngology

Faculty of Medicine

University of Tokyo

7-3-1 Hongo, Bunkyo-ku

Tokyo, Japan 113-8655

References

1. Natvig K, Larsen TE. Mucocele of the paranasal sinuses. A retrospective clinical and histological study. J Laryngol Otol. 1978;92:1075-82

2. Som PM, Shugar JM. Antral mucoceles: a new look. J Comput Assist Tomogr. 1980;4:484-8

3. Granz H. Postoperative mucoceles of the maxillary sinuses [German]. HNO. 1979;27:267-70

4. Hasegawa M, Saito Y, Watanabe I, Kern EB. Postoperative mucoceles of the maxillary sinus. Rhinology. 1979;17:253-6

5. Iinuma T, Tanaka T, Kase Y, Ishio K, Kuriyama J, Hukuda M. On the postoperative mucocele of the maxillary sinus and its simulating cases. A clinical treatise [Japananese]. Nippon Jibiinkoka Gakkai Kaiho. 1992;95:665-73

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


Copyright © 2004 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Article Tools

  • Print page
  • Share this page
  • AFP CME Quiz

Information From Industry

Navigate this Article