Sinus Related Eye Pressure or Something Else?

[Efyl]

Over the past 2 1/2 to 3 months I have suffered from pressure behind my eyes which has bothered me most upon waking up and when doing sitting, focused work like working at the computer, reading, or driving. For the first few weeks when the pressure was very great I also had on and off dull headaches or flashes of pain, reminiscent of  sinus pressure but without any congestion whatsoever. I've been to various doctors and have been urged to try decongestants, loratamine-based OTC's, Flonase, and antiobiotics. While the symptoms did mitigate and kind of have since flat-lined, it seems that the mitigation of symptoms wasn't really associated with any of those medications (it's too lengthy to explain the timeline here of what I took when, etc.). Anyway, I've had two CT Scans--one of my sinuses that found evidence of past sinus infection, a nasal bone spur, and a deviated septum. I visited an ENT and he didn't feel concerned that what was found was causing my symptoms. The second one was an orbital one to see if there was anything going on around my eyes (as my eyes checked out fine). My doctor said that the radiologist said there is evidence of sinus disease. Perhaps entirely separate or perhaps not, I have during the same time period suffered from what I call "computer strain symptoms" of wrist/hand soreness and neck and shoulder tightness (something I had experienced in the past). Blood tests show that I don't have autoimmune disease, Lyme, or thyroid issues. Everything turns me up as being in perfect health. So, my question is--are there forms of sinus disease that can last for months, survive weeks of antibiotics, and don't produce congestion? OR . . . could it be that my history of computer-related strain and the clear tension I have in the back of my head/neck may be referring sensations. Thanks! Where should I go from here?

[Vivek V Gurudutt, MD]

Good question.  I am happy to hear that you have made a concerted effort of being evaluated and had a complete work up.  I applaud your efforts.  It is possible to have isolated sinus cells that have disease and don't respond to therapy as they do not drain well.  This process would most likely show up on ct scanning.  There would be fluid or mucosal thickening in the cell.  It is also possible (and subject to some discussion) that contact points of opposing mucosal surfaces in the nose can lead to atypical pain sensations.  Patients with septal deviation or spurs may have contact points to structures on the lateral nasal wall and lead to discomfort.  Not all otolaryngologists agree on this point.  It is possible to have symptoms associated to work related strain as you described.  Another avenue to pursue would to rule out any type of headache syndrome that could be associated.  A neurologist would be helpful in this regard.  Good luck.

[gmoorhouse]

Can you answer the SAA question from a septoplasty surgery?

I had septoplasty surgery for a deviated septum and they had a dx of "SAA" pre and post op from my specimen of septum.

[gmoorhouse]

Thanks much.

Well I seen the neuro and they thought maybe prior I had mennengitis.

I will ask about that image guided surgery, thanks again.  The ENT I will be an appt with I'm not sure I want him to do it but I do need a sinus CT and see what is going on.

I do know my brain mri (due to the PGW) it noted about mucosal thickening.

I'm just curious about the SAA.......too curious.

[Sammie4258]

STick to your guns.  You are headed to the right place.  Make sure they do a CT Scan and when they do the surgery it is imagery guided.  this helps prevent possible puncture that could lead to mennengitis or spinal fluid leak.  Dont let this scare you.  you will be in good hands.  Just get a well trusted ENT.  He will know what to do.  Ask him if he uses image guided surgery.  
My surgery went well but I had all sorts of problems when they got inside..  The 1 inch cyst was clear full of infection along with all my sinuses. I had a severe fungal or yeast problem.   I also had several polyps they had to remove.  They had to biopsy these due to my breast cancer history.  So I am a little scared for the results but again don't let this scare you.  You just take care of it and follow doctors orders closely.  if your ct scan says mild mucosal thickening, be on your guard to take action.  Mine went from mild to severe in a matter of months.  Pay attention to what he says about the mucosal thickening. any questions, you know where to find me.  

[gmoorhouse]

I have a few things.

First does anyone know what SAA means?  I had septoplasty surgery for a deviated septum and they had a dx of "SAA" pre and post op from my specimen of septum.

Second, I have the same headaches that Efyl and Sammie4529 describe.  I did have a CT and cysts in my maxillary, spehnoid (which seems to be the pain that some get in their eyes from), ethionoid (spelling) and other things.

I also get those deep eye pains.  I went to my physical.....no relife...........eye doctor, he thought it was eye strain......got so bad went to ER they said dx headaches, take pain meds and go home.  I did see a Neuro and talked about some of the headaches but I never been dx with migraines but some are that type and some are cluster...........some are that neck pain kind of a tension........I do not know what is wrong.

I have read that a cyst in the sphenoid can cause eye pain, neurological problems as well.........


Efyl let us know how your surgery goes.  I just seen my family doctor to get a referral to an ENT again for the same thing as you.

[Sammie4258]

Correction:  not 205cm, but 2.5 cm
I went back and read your post, apparently you did do a scan.  Just know that this can worsen over time.  so please stay on top of it.  If antibiotics do not help you are way past that point and need surgery.  Might want a second opinion.  

[Sammie4258]

Forgive me, I had to laugh a bit. I go in for surgery tomorrow for the exact same thing.  I have the exact symptoms. Headaches, pressure.  Everything you mentioned here  right down to the neck and back of the head pain.  I don'tknow how the neck and headache in the back of the head is involved but I will find out tomorrow.  The docor is correct in his opinion.  You need to see ENT specialist and run a sinus CT Scan.  I am sure this is going to show up on your scans.  Also, one of the problems with the trapped fluid is the possible Retention Cyst.  I have that also.; 205cm
  I am 110% sure the ENT is going to tell you the same thing that I have.  And yes, this can last for months.  It will require surgery if the antibiotics have not worked by now.   Listen, good luck and wish me good luck tomorrow.  I'll let you know how it goes.  In the mean time,  I would be seeing the ENT
sammie