Acute Unilateral Isolated Ptosis as a Complication of Frontal Sinusitis: A Case Report
Keywords:
Keywords: cranial nerve (CN) III palsy, oculomotor nerve palsy, pediatric, ptosis, sinusitisAbstract
ABSTRACT
Objective: Acquired upper-eyelid ptosis can be traumatic, mechanical, neurogenic, or myogenic in origin. However, oculomotor nerve or cranial nerve (CN) III palsy caused by frontal sinusitis is extremely rare. The purpose of this report is to document an unusual case of frontal sinusitis in a 15-year-old boy with acute unilateral ptosis as the sole presenting sign of CN III palsy.
Case report: A 15-year-old Thai boy presented with a 2-day history of left-sided upper-eyelid ptosis preceded by a 1-week history of influenza A infection. His pupils were equivalent in size bilaterally, and extraocular muscles exhibited full motility. Magnetic resonance imaging of the brain and orbit revealed fluid opacification and mucosal thickening, predominantly in the left frontal sinus, with no levator palpebrae superioris abnormalities. The case was diagnosed as frontal sinusitis associated with CN III palsy. The ptosis had completely resolved by the fifth day of intravenous levofloxacin.
Conclusions: Frontal sinusitis can lead to palsy of the superior branch of CN III presenting with only isolated ptosis. This case highlights a potential complication of acute sinusitis and raises awareness of a rare differential diagnosis in isolated, unilateral ptosis. Diagnostic neuroimaging may assist in managing such atypical cases.
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