Purpose: To study the prevalence of glaucoma among adults with migraine and the effect of migraine on peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) using optical coherence tomography (OCT) compared to those without migraine headache, i.e. in tension-type headache (TTH) and normal group. Methods: One hundred and eleven patients (222 eyes) were recruited in three groups. migraine, TTH, and normal subjects visiting hospital outpatient services. After noting demographic details and pertinent history, ophthalmological evaluation including optic disc for glaucomatous changes along with computerized visual field testing and OCT for pRNFL thickness and CMT was performed in all eyes. Continuous variables were compared using ANOVA or Kruskal–Wallis test, while categorical variables including the association of glaucoma with migraine were analyzed using Chi-square or Fisher’s exact test. Results: Prevalence of glaucoma in migraine group (12.2%) was more than in comparison groups (6.8% in TTH, 4.1% in normal) which was however not significant (Fisher’s exact P = 0.207). Average pRNFL thickness (103.59 ± 12.82 μm) and thickness in nasal (90.49 ± 19.19 μm) and temporal quadrants (70.58 ± 16.13 μm) and CMT (213.78 ± 19.81 μm) were significantly reduced (ANOVA P < 0.05) in migraine patients when compared to the other groups and this was independent of the presence of glaucoma. Conclusion: Prevalence of glaucoma is not significantly higher in migraine patients. However, migraine causes thinning of retinal layers on OCT that is statistically significant.

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Sphenoid sinus mucoceles (SSMs) can rarely cause acute bilateral vision loss. We, hereby, report such a rare case of SSM in a 20-year-old female who presented with sudden onset bilateral diminution of vision. The best-corrected visual acuity was 20/400 in the right eye (RE) and hand movements in the left eye (LE). Both eyes had sluggish pupillary reactions. Both eyes had normal fundus. Initial treatment was started with a provisional diagnosis of bilateral retrobulbar neuritis, but imaging revealed a large SSM compressing bilateral optic nerves. The patient underwent urgent surgical decompression. Vision in RE improved to 20/20 and LE to 20/400. A high index of clinical suspicion for compressive lesions is needed in all cases of atypical optic neuritis.