Silent Sinus Syndrome: A Rare Cause of Diplopia in Elderly

Silent Sinus Syndrome (SSS) is an uncommon and often underrecognised condition, particularly in the elderly, as the average age of onset is around 39 years old. It is characterised by spontaneous enophthalmos and/or hypoglobus secondary to ipsilateral maxillary sinus collapse. While diplopia is the most frequently reported symptom, its presence in older adults is often attributed to other causes due to comorbidities or medication side effects, leading to diagnostic delays. We report the case of a 76-year-old man presenting with intermittent diplopia. Clinical examination revealed esotropia and hypotropia. Imaging showed asymmetry of the maxillary sinuses and downward displacement of the left orbital floor, confirming the diagnosis of left-sided SSS. The patient underwent septoplasty and middle meatal antrostomy. Follow-up at six months revealed trace improvement in ocular alignment and partial re-expansion of the maxillary sinus. A review of the literature revealed only 10 reported cases of SSS in patients aged 65 years or older, some of whom experienced delayed diagnosis. This case highlights the need to consider SSS in the differential diagnosis of diplopia in elderly patients. Increased clinical awareness may help prevent misdiagnosis and ensure timely management of this rare but treatable condition.