Aqueous humor outflow occurs through the conventional and unconventional pathway. With aging, the latter becomes less active so that the conventional pathway remains the primary mechanism of aqueous humor outflow. An abnormality of this pathway contributes significantly to disordered aqueous humor dynamics and consequent rise in intraocular pressure seen in primary open angle glaucoma and ocular hypertension. Recently, the ocular lymphatics have been implicated in aqueous humor outflow. Additionally, the trabecular meshwork is now understood to be a complex organization of structures, which are controlled by various biomechanical and biochemical mechanisms. Among others, these include the actinomyosin cytoskeletal system, extracellular matrix, intracellular signaling responses mediated by protein kinase C, Rho/Rho kinase, and other biologic factors. This review shall describe the various pathophysiologic mechanisms involved in aqueous humor dynamics.

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Recurrence of nasopharyngeal carcinoma (NPC) is still a worrying issue despite the advent and advancement of treatment strategies. Presentation of recurrent NPC is different from primary NPC and indicates poor prognosis. Frontal sinus metastasis without any involvement of other sinuses is very rare and could be mistaken as sinusitis or mucocele. Owing to its rare occurrence, it presents a great challenge for clinicians to make a prompt diagnosis. The background chronic rhinosinusitis symptoms as a result of irradiation for NPC may masquerade the underlying paranasal sinus recurrence.