title: Ophthalmic manifestations of paranasal sinus disease: a clinical grading system.
abstract: BACKGROUND
  Ophthalmic complications are common manifestations of paranasal sinus disease. We propose a clinical grading system to standardize the category, treatment, and outcome of these complications.
  
  
  METHODS
  Forty-two patients with paranasal sinus disease-induced ophthalmic complications were included in the study. The patients were categorized according to their clinical presentation: Grade I, patients with anatomical disturbance; Grade II, patients with ophthalmic functional involvement; Grade III, patients with orbital infection; and Grade IV, patients with visual impairment.
  
  
  RESULTS
  The age of the patients ranged from 8 to 65 years (mean = 30 years). Overall, 36% patients had ophthalmologic manifestations with anatomical disturbance (Grade I), 26% had functional disturbance (Grade II), 26% had orbital infections (Grade III), and 12% had visual loss (Grade IV). The cause of the ophthalmic manifestations was allergic fungal sinusitis in 50%, chronic rhinosinusitis in 36%, acute sinusitis in 10%, and mucocele in 4%. The most common ophthalmic manifestation was proptosis (36%), followed by orbital infection (26%), functional involvement (26%), and visual impairment (12%). The patients underwent functional endoscopic sinus surgery and medical treatment when indicated. The outcome in Grades I, II, and III was favorable; the outcome in Grade IV was not favorable.
  
  
  CONCLUSIONS
  This simple clinical grading system provides a useful tool for assessing the overall status of ophthalmic complications of Acute and chronic paranasal sinus disease at the initial clinical assessment and for subsequent management of these complications.
authors.affiliation: Ear, Nose, and Throat (ENT) Department, King Saud University Medical College, Riyadh, Saudi Arabia. waelamro@hotmail.com
authors.forename: Fatma H
authors.initials: FH
authors.lastname: Al Anazy
authors.forename: Surayie H
authors.initials: SH
authors.lastname: Al Dousary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002908:Chronic Disease; D004724:Endoscopy; D005094:Exophthalmos / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D015821:Eye Infections, Fungal / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D012220:Rhinitis / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012720:Severity of Illness Index; D012852:Sinusitis / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome; D014786:Vision Disorders / Q000145:classification* / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult