Isolated Ptosis in Acute Sinusitis: Case Report and Literature Review

Acute sinusitis is usually a straightforward diagnosis characterised by nasal blockage or discharge, with facial pain, pressure or headache, and reduced or loss of smell. However, some features may be present suggesting neurological or ophthalmic disease, and thus complicate the diagnostic process and delay management. In particular, isolated ptosis is a rare presentation of acute sinusitis with only six published cases to date. A usually fit and well 33-year-old male presented with an acute right-sided drooping upper eyelid. It was associated with a 1-week history of frontal headache worse on bending forward and sneezing, and right eye pain and pressure. The physical examination confirmed a right-sided ptosis with preserved eye movements and pupillary responses. Computed tomography (CT) of the head and sinuses showed pansinusitis primarily affecting the right maxillary and ethmoid sinuses and excluded an intracranial and orbital cause for the ptosis. He was treated for acute sinusitis and discharged the same day with a 1-week course of oral doxycycline, advice about steam inhalation and follow-up in the outpatient ear, nose and throat (ENT) clinic in 1 week, and he subsequently fully recovered. Isolated ptosis in acute sinusitis remains a rare presentation of a common condition which is poorly recognised by clinicians. We contributed another case report to the limited literature on this topic and performed the first literature review to provide clinicians with a better understanding of isolated ptosis in acute sinusitis while importantly raising its awareness.