Presumed sinus-related strabismus

Purpose: To determine whether sinus disease may cause acquired strabismus. Methods: Patients with idiopathic acquired (nonaccommodative) esotropia and/or hypotropia were questioned in detail about possible contributing factors (trauma; family history of strabismus; thyroid, neurologic, or rheumatologic disorders). Acute versus chronic onset was ascertained. Those without obvious cause of strabismus were investigated for possible sinus disease with sinus computed tomographic scan and otolaryngologic consultation. Results: Over a period of 5 years, 59 patients were identified with sinus disease that correlated to their strabismus pattern(s). Twenty-three had "possible" sinus-related strabismus. They had sinus findings that correlated with the strabismus pattern (eg, hypotropia and adjacent maxillary sinus disease). Twenty-six had "likely" sinus-related strabismus. These patients had additional features, such as their own recognition that strabismus worsened along with sinus symptoms, or unusually severe sinus disease. Ten were diagnosed with "very likely" sinus-related strabismus. They had strong correlation between treatment of sinus disease and strabismus improvement. Eighteen patients required sinus surgery owing to failure of medical control. Age at onset of strabismus ranged from 6 months to 81 years. Forty patients required strabismus surgery. All had restriction of motility on forced duction testing under anesthesia. Control of sinus disease combined with range-of-motion eye exercise improved symptoms in 19 who did not require strabismus surgery. Conclusions: Occult sinus disease may cause acquired strabismus. Perhaps sinusitis leads to inflammation and secondary contracture in adjacent extraocular muscles. Although difficult to prove owing to the high frequencies of both strabismus and sinus disease, the association between the two may prove significant to strabismus treatment and long-term control.