title: Advanced cocaine-related necrotising sinusitis presenting with restrictive ophthalmolplegia.
abstract: We report a case of bilateral infero-medial orbital wall destruction, associated with loss of sinonasal architecture. The patient presented with intermittent horizontal diplopia following an acute on chronic infective sinusitis. Eight months previously the patient had developed a midline hard palate fistula for which a palatine prosthesis had been fitted. The broad differential diagnosis is discussed, though in this patient chronic cocaine abuse was identified as the underlying aetiology. Eye movement restriction worsened progressively with bilateral inflammation around the medial and inferior rectus muscles. Attempts to resolve the recurring cycle of sinus infection and inflammation by palatal fistula closure failed despite augmented techniques mobilising flaps from both nasal and palatal sides.
authors.affiliation: a West Kent Eye Centre , Princess Royal University Hospital, Farnborough Common , Orpington , Kent , United Kingdom.
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Lascaratos
authors.affiliation: a West Kent Eye Centre , Princess Royal University Hospital, Farnborough Common , Orpington , Kent , United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: McHugh
authors.affiliation: a West Kent Eye Centre , Princess Royal University Hospital, Farnborough Common , Orpington , Kent , United Kingdom.
authors.forename: Karon
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: a West Kent Eye Centre , Princess Royal University Hospital, Farnborough Common , Orpington , Kent , United Kingdom.
authors.forename: Howard
authors.initials: H
authors.lastname: Bunting
mesh_terms: D000281:Administration, Intranasal; D019970:Cocaine-Related Disorders / Q000175:diagnosis* / Q000209:etiology; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000209:etiology; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology*; D010159:Palate / Q000473:pathology; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000473:pathology*; D012852:Sinusitis / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Cocaine; necrotising sinusitis; ophthalmoplegia; orbital disease