Marc, All great questions and they have more to do with kayak building than you can believe. Nick would have caught this much earlier than most doctors. The short answer is that it is a localized demineralization, the theory is it is created somewhat due to a vacuum that is created and some associated chemical reactions for lack of a better term. The issue is pretty rare and among the doctors that are aware of it many are skeptical. The surgeon that actually performed the surgery actually shifted from a denier (for very good reasons) to being fully converted over the past few weeks. From the very beginning I knew that I had a bad sinus problem but had no pain from it, but no doctor would accept that had anything to do with my vision issue and I was looking for the link. They were focused on the nerves because the nerves are not stimulating the muscle and they were focused on my left eye where the symptoms are most manifested and the sinus issue was on the right side. When I looked at the right eye where the sinus is bad (left side of picture, and by the way the sinus around the left eye is almost perfect) I immediately recognized I had a structural issue on one side or the other. I looked at an anatomically correct skull model I have that is part of an entire skeleton (a story for another day) and it supported my theory and clued me in to the right side being bad and I pictured a friends kayak that had been compromised internally by moisture and then experienced a sudden vacuum when it was exposed to water with a sealed hatch and no vent hole and it imploded (this is where Dr. Nick would have hit the bullseye much earlier). I then studied the MRI very carefully (and later a c-scan which happens to pick up this type of issue much better). I determined my eye had actually shifted 2-3 mm back and about the same distance down and the orbital floor had essentially caved in. Even before I got the images I had concluded the same thing just by feeling where my eye met my skull at the top, I knew one eye was sitting very differently than the other one. So I understood what had happened I just didn't understand the mechanism that made it happen. My next challenge was finding the right specialist. Fortunately I have a rather large global network in the healthcare arena and interestingly found the right person about 50 miles away from my home. It is a setting similar to the Mayo Clinic and clearly one of the best places to go for severe vision issues. I had embarrassed myself several times showing a copy of the image to other doctors just to have them discount it, now that I understand the disease better I understand why. What I really needed was a doctor that had experience building kayaks. So when I went into my testing with the new group I showed it to one of the medical team who downplayed it but she did share it with the lead doctor. The image is in a stack you typically would not look in for the symptoms I was experiencing. The lead doctor immediately recognized it and knew just what was going on. I am a long ways from being out of the woods and neurological concerns are still very much on the table but I am feeling good about the whole thing. So the bottom line is if you forgot to crack your hatches before you put your kayak away for the winter do it now and make sure you always drill a vent hole in the bulkhead. If any of you are curious about the disease here is a link. http://www.aao.org/eyenet/article/diagnosis-management-of-silent-sinus-syndrome?julyaugust-2011
This image is not the most significant from a medical standpoint but illustrates the kayak effect best. Kind of expensive technology for boat repair but it does illustrate the problem.