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|Year : 2021 | Volume
| Issue : 4 | Page : 1125-1126
Optic Neuropathy Caused by an Ethmoid Sinus Mucocele Encasing the Optic Nerve
Kwang Soo Lee1, Dae Woong Bae1, Jinhee Jang2, Woojun Kim1
1 Department of Neurology, The Catholic University of Korea, College of Medicine, Seoul, South Korea
2 Department of Radiology, The Catholic University of Korea, College of Medicine, Seoul, South Korea
|Date of Submission||31-May-2019|
|Date of Decision||22-Nov-2019|
|Date of Acceptance||15-May-2021|
|Date of Web Publication||2-Sep-2021|
Department of Neurology, The Catholic University of Korea, College of Medicine, 222 Banpo-daero, Seocho-gu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Lee KS, Bae DW, Jang J, Kim W. Optic Neuropathy Caused by an Ethmoid Sinus Mucocele Encasing the Optic Nerve. Neurol India 2021;69:1125-6
A 60-year-old woman with a history of hypertension and hyperlipidemia presented with decreased visual acuity and pain in the right eye that was aggravated for two days and associated with headache in the right frontal area. She had no recent history of upper respiratory infection, sinusitis, or trauma. On examination, the visual acuity of her right eye was at the level of light perception, which was shown on Humphrey perimetry [Figure 1]a. Pupils were round and isocoric; however, the light reflex was sluggish on the right side with a relative afferent pupillary defect. Eye movements were full in all directions. Fundus examination revealed normal discs in both eyes. No other systemic or neurological abnormalities were found. Magnetic resonance imaging showed a cystic mass in the right posterior ethmoid sinus, suggesting a mucocele encasing the right optic nerve [Figure 1]b, [Figure 1]c, [Figure 1]d. Under a diagnosis of compressive optic neuropathy associated with the ethmoid sinus mucocele, an endoscopic ethmoidectomy was performed [Figure 1]e, and the patient's symptoms completely resolved after two weeks.
|Figure 1: (a) Humphrey visual field tests revealed total blindness in the right eye. (b) Coronal T2-weighted image, (c) axial T2 FLAIR image, and (d) contrast-enhanced serial T1-weighted axial images show a well-defined mucocele occupying the right posterior ethmoid sinus (asterisk), extending to the right clinoid process (arrowhead), encasing the optic nerve (arrow). (e) Sinus endoscopy finding of right ethmoid sinus mucocele|
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Differential diagnosis of acute visual loss includes various diseases, including optic neuritis, arteric/nonarteric ischemic optic neuropathy, and compressive optic neuropathy, as in this case. Her clinical features and examination findings correlated with retrobulbar optic neuropathy. Mucoceles causing compressive optic neuropathy occupying the sphenoidal sinus or concurrently sphenoidal and ethmoidal sinuses have been reported. However, to our knowledge, this is the first report describing a mucocele located in the ethmoidal sinus causing compressive optic neuropathy.
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Li E, Howard MA, Vining EM, Becker RD, Silbert J, Lesser RL. Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systemic review. Orbit 2018;37:280-6.