To report what we believe to be the first case in the English language literature of unilateral cavernous sinus thrombosis complicating contralateral sphenoid sinusitis.

A 62-year-old man presented to his general practitioner with a severe, right-sided, temporal headache. He was diagnosed with temporal arteritis and treated with systemic steroids. After five days, he developed right proptosis, ophthalmoplegia and ptosis. He was referred to the neurologists. After an urgent computed tomography head scan and computed tomography angiogram, a diagnosis of carotido-cavernous fistula was made. However, this was subsequently excluded after a negative cerebral angiogram. A review of the scans enabled diagnosis of right cavernous sinus thrombosis secondary to left sphenoiditis. The patient was referred to the otolaryngology team. After an urgent endoscopic sphenoidotomy and medical treatment, all symptoms and signs improved dramatically.

Sphenoiditis can lead to contralateral cavernous sinus thrombosis. Urgent surgical sphenoidotomy, with appropriate medical treatment, can be successful in this life-threatening complication.

We report a rare case of a nasal glioma found incidentally in an adult, presenting with visual loss, optic nerve oedema and proptosis.

A 41-year-old woman presented with bilateral proptosis, impairment in visual acuity (6/60 bilaterally) and loss of colour vision. Computed tomography and magnetic resonance imaging showed proptosis, bilateral optic nerve swelling and a heterogeneous mass occupying the left nasal cavity and extending through a skull base defect into the anterior cranial fossa. Biopsy confirmed a nasal glioma. Treatment with intravenous dexamethasone resolved the proptosis, and the patient's visual acuity recovered to 6/9 bilaterally. At the multidisciplinary team meeting, it was felt that the nasal glioma probably represented an incidental finding and was not directly responsible for the patient's proptosis and transient visual loss.

To our knowledge, this is the first report in the English language literature of adult nasal glioma presenting with visual loss. The management of nasal gliomas in adults is contentious and the relevant literature is reviewed. This case was managed conservatively with regular follow up.

To document the results of endoscopic orbital decompression performed in a group of patients with thyroid eye disease in order to improve cosmesis.

A retrospective case review was performed of all patients who had undergone endoscopic orbital decompression for cosmesis in our departments during the period January 1996 to September 2002. A postal questionnaire was sent to all patients who had undergone the operation, in order to assess patient satisfaction.

Twenty orbits of 15 patients underwent endoscopic decompression. For all orbits, the reduction in proptosis was 3.7±2.2 mm (mean±standard deviation; t = 6.5, p = 0.001). For 16 of the endoscopic decompressions (89 per cent), patients reported that they were satisfied with the appearance of their eye post-operatively, and all patients reported a reduction in eye prominence post-operatively.

Endoscopic decompression is an effective procedure for improving cosmesis in patients with inactive thyroid eye disease.