Eye/orbit pain for a few months, please help

#19 05-08-2007, 06:01 PM

dr. tyner, thanks for the reply.

I got a message from eye doctor recommending an ENT doctor, I haven't
decided to go to see him yet (very little information available about
him). I searched for some ENT doctors, I don't see any specialized in
chronic sinusitis, but found a few in Sinus Disorders/Surgery, is that
the specialty best suit my situation?

#18 05-07-2007, 11:59 PM

<ns666ns[at]yahoo.com> wrote

- quote -

> dr judy thanks for the reply, will ENT doctor know what that "single
> white lesion" means? I have 3 print out images, I don't know if ENT
> doctor can locate the thing from pictures or need cooperation from
> imagining center? I don't see "exact location" on the report. do I
> need to see a neurologist?

I didn't see "single white lesion" in the report. If you're talking about
the "small hyperintensity lesion" it's probably ancient history and it's
located such that you wouldn't do any sort of surgery without knowing it
represents a major problem. Which isn't likely, from the report.

-MT

#17 05-07-2007, 11:48 PM

<ns666ns[at]yahoo.com> wrote

- quote -

> dr. tyner, thanks for the reply, I just noticed the cysts as you said
> is located on the right cheerbone,

It's inside the right maxillary sinus and "polyp vs retention cyst" means
the MRI can't distinguish between these two fairly benign conditions.

- quote -

> head, and as you said if cysts usually doesn't hurt, is it relatively
> safe to assume that it's not the cause of the pain?

It isn't safe for you or me to assume anything. I'd get some advice about
the polyp/cyst - I have no experience with those, except they aren't likely
inflammatory and not likely the cause of your (more generalized) pain.

I suggested returning to the ophthalmologist because I gather you're paying
out-of-pocket and this doctor already knows you so you'll get further
information and advice without paying for an entire new workup. If he
recommends an ENT doc, then you know that's the best route to take. I'd be
surprised if he gets alarmed about the polyp/cyst.

-MT

#16 05-07-2007, 07:05 PM

ns666ns[at]yahoo.com wrote in news:1178562833.562958.154490
[at]p77g2000hsh.googlegroups.com:

- quote -

> dr judy thanks for the reply, will ENT doctor know what that "single
> white lesion" means? I have 3 print out images, I don't know if ENT
> doctor can locate the thing from pictures or need cooperation from
> imagining center? I don't see "exact location" on the report. do I
> need to see a neurologist?
> thanks

The ENT probably won't deal with the white *matter* lesion, but try to make
sure your primary care physician gets a copy of the report.

It really sounds like your problem is sinuses, though. Give the ENT his
crack at it. You've had three or four practitioners tell you that your
problems sound sinus-related, and an MRI confirming chronic sinusitis. The
"tumor" that is more likely related to your pain is sinus-related, and
likely has nothing to do with the white matter lesion.

Do some googling for gliosis, and make sure your primary doctor knows about
it. My suspicion is that they may want follow up imaging at some time in
the future, but that nothing will really be done unless you show
neurological symptoms-- or maybe if the sinus stuff is cleared up and your
pain remains.

--
Scott (not a doctor)
Reverse name to reply

#15 05-07-2007, 06:33 PM

dr judy thanks for the reply, will ENT doctor know what that "single
white lesion" means? I have 3 print out images, I don't know if ENT
doctor can locate the thing from pictures or need cooperation from
imagining center? I don't see "exact location" on the report. do I
need to see a neurologist?

thanks

#14 05-07-2007, 03:03 AM

On May 5, 10:51 pm, ns66...[at]yahoo.com wrote:
- quote -

> Hi, I tried cephalexin for 10 days and sudafed for 6 days, it didn't
> seem to cure it, I still feel the pain. so I went to a MRI imaging
> center and did MRI 1.5T for orbits and brain. here is the report:
> The ventricles and sulci are within normal limits. The flair imaging
> demonstrates a small hyperintensity lesion in the right frontal
> subcortical white matter. the brain parenchyma is otherwise normal in
> signal intensity and configuration. No acute hemorrhage, mass lesion
> or mass effect is demonstrated intracranially. the patient has septum
> pellucidum, normal variant. there is no extraaxial collection. the
> sella is normal in size. the craniovertebral junction is normal. the
> internal carotid arteries and basilar artery show normal flow void
> signal intensity.
> the globes are normal in size and configuration. the optic nerves are
> normal in size, course and signal intensity. the extraocular muscles
> and retrobulbar fat are unremarkable bilaterally. the optic chiasm is
> intact.
> there is mild mucosal thickening of the bilateral ethmoid, frontal
> and maxillary sinuses compatible with chronic sinusitis. the right
> maxillary sinus demonstrates a polyp versus retention cyst measuring
> 1.8x.1.8 cm in the inferior all. there's no evidence of air-fluid
> level. the osteomeatal complex is patent bilaterally. the nasal
> septum is midline. the nasal cavity is unremarkable.
> IMPRESSION:
> 1. single small right frontal white matter lesion is nonspecific and
> may represent small vessel ischemic disease or gliosis.
> 2. normal variant septum pellucidum
> 3. chronic paranasal sinusitis.
> 4. polyp versus retention cyst in the right maxillary sinus.
> I don't understand much about this report, seems like there's a
> sizable tumor that need be removed? is that the reason I feel the
> pain? if it's I am happy at least I know what's the cause.
> what kind of doctor do I need to see? a surgeon?
> thank you very much.

The doctor who ordered the MRI should be following up and advising you
on the next steps. Likely will involve an ear, nose and throat doctor
as the sinuses are involved. Whether or not a tumour needs to be
removed depends on what the term "single white lesion" means and you
and most of us are not in a position to know that.

Dr Judy

#13 05-06-2007, 10:16 PM

dr. tyner, thanks for the reply, I just noticed the cysts as you said
is located on the right cheerbone, which is not where it hurts, the
pain is on the right eyebrows area closer to the nose and goes inside
head, and as you said if cysts usually doesn't hurt, is it relatively
safe to assume that it's not the cause of the pain?

chronic paranasal sinusitis is most likely the cause of the pain? can
it be cured? I took 10 days of cephalexin and went back to my old pair
of glass (with nose pieces lower than the new pair and worn for 10
years without pain), the pain is less but still there... I already
mailed the report to my eye doctor.

thanks

#12 05-06-2007, 08:14 PM

thanks for the reply

#11 05-06-2007, 05:16 AM

On May 5, 7:51 pm, ns66...[at]yahoo.com wrote:
- quote -

> Hi, I tried cephalexin for 10 days and sudafed for 6 days, it didn't
> seem to cure it, I still feel the pain. so I went to a MRI imaging
> center and did MRI 1.5T for orbits and brain. here is the report:
> The ventricles and sulci are within normal limits. The flair imaging
> demonstrates a small hyperintensity lesion in the right frontal
> subcortical white matter. the brain parenchyma is otherwise normal in
> signal intensity and configuration. No acute hemorrhage, mass lesion
> or mass effect is demonstrated intracranially. the patient has septum
> pellucidum, normal variant. there is no extraaxial collection. the
> sella is normal in size. the craniovertebral junction is normal. the
> internal carotid arteries and basilar artery show normal flow void
> signal intensity.
> the globes are normal in size and configuration. the optic nerves are
> normal in size, course and signal intensity. the extraocular muscles
> and retrobulbar fat are unremarkable bilaterally. the optic chiasm is
> intact.
> there is mild mucosal thickening of the bilateral ethmoid, frontal
> and maxillary sinuses compatible with chronic sinusitis. the right
> maxillary sinus demonstrates a polyp versus retention cyst measuring
> 1.8x.1.8 cm in the inferior all. there's no evidence of air-fluid
> level. the osteomeatal complex is patent bilaterally. the nasal
> septum is midline. the nasal cavity is unremarkable.
> IMPRESSION:
> 1. single small right frontal white matter lesion is nonspecific and
> may represent small vessel ischemic disease or gliosis.
> 2. normal variant septum pellucidum
> 3. chronic paranasal sinusitis.
> 4. polyp versus retention cyst in the right maxillary sinus.
> I don't understand much about this report, seems like there's a
> sizable tumor that need be removed? is that the reason I feel the
> pain? if it's I am happy at least I know what's the cause.
> what kind of doctor do I need to see? a surgeon?

It seems like sinusitis, so the answer is almost obvious: ENT.

#10 05-06-2007, 04:43 AM

<ns666ns[at]yahoo.com> wrote

- quote -

> I don't understand much about this report, seems like there's a
> sizable tumor that need be removed? is that the reason I feel the
> pain? if it's I am happy at least I know what's the cause.
> what kind of doctor do I need to see? a surgeon?

Polyps and fluid retention cysts don't usually hurt. Sinusitis usually
hurts.

Yours is pretty generalized, not localized to the right cheekbone.

I'd recommend you return to the ophthalmologist who ordered the MRI, hoping
he'd treat the inflammation before trying to cut anything out.

-MT

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