A 46-year-old woman was admitted to the hospital in March 2005 with a 6-month history of pain in the external third of the left upper eyelid, accompanied by a decrease in ipsilateral visual acuity (VA).
The patient reported the development of a similar mass 15 years prior to admission, which was successfully managed with unspecified medical treatment.
The rest of the history was unimportant for the current disease.
Examination revealed a VA of 0.7 in the right eye (OD) and 0.2 in the left eye (LE).
In the external third of the left upper eyelid there was a 4 ¥ 3.5 cm mass, painful accompanied by ptosis, inferior displacement of the eyeball on the same side.
He had limitation to levoupraversion of the left eye.
Exophthalmoscopy with base 100 was 17 mm for both eyes.
Patellar opening was 10 mm in the RE and 4 mm in the LE.
Left elevator muscle function was limited.
A computed tomography of both orbits with axial and coronal sections was requested, in which a temporal mass of cystic appearance with bone destruction in the left frontal sinus and apparently displaced the eyeball was demonstrated.
The mass was aspirated and a dense colorful liquid was obtained.
In a smear of this content few Gram positive cocci were found in pairs and chains, accompanied by numerous polymorphonuclear leukocytes and abundant mucus.
Treatment was initiated with ampicillin, dicloxacillin, and topical NSAID and acetamide.
The patient underwent drainage of the paranasal sinus content with removal of its wall.
Microscopically, preparations stained with hematoxylin and eosin showed fragments lined by respiratory epithelium.
Below the epithelium, the wall was formed by a stroma of dense connective tissue with areas of hemorrhage mixed with many variables of inflammatory infiltrate formed by mature lymphocytes, plasma cells, numerous polymorphonuclear leukocytes and eosinophils.
The diagnosis of frontal sinus mucocele was established.
The presence of large amounts of eosinophils as part of the inflammatory infiltrate suggested a probable allergic or hypersensitivity-type etiology.
