Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases

Abstract

BackgroundVisual disturbances associated with isolated sphenoid sinus inflammatory diseases (ISSIDs) are easily misdiagnosed due to the nonspecific symptoms and undetectable anatomical location. The main objective of this retrospective case series is to investigate the clinical features of visual disturbances secondary to ISSIDs.MethodsClinical data of 23 patients with unilateral or bilateral visual disturbances secondary to ISSIDs from 2004 to 2014 with new symptoms were collected. Collected data including symptoms, signs, neuroimaging and pathologic diagnosis were analyzed.ResultsThere were 14 males and 9 females, and their ages ranged from 31 to 83 years. Fifteen patients suffered blurred vision and 11 patients suffered binocular double vision, including 3 patients who had unilateral visual changes and diplopia simultaneously. Headache was observed in 18 patients, and orbit pain/ocular pain in 8 patients. Other presenting symptoms included ptosis (4 patients) and proptosis (1 patient). Only 5 patients had nasal complaints. The corrected visual acuities were between NLP to 20/20. Patients with diplopia included 5 with unilateral oculomotor nerve palsy and 6 with unilateral abducens nerve palsy. All patients performed orbital/sinus/brain radiologic examination and found responsible lesions in sphenoid sinus. All patients underwent endoscopic sinus surgery, and 9 patients were found to suffer sphenoid mucocele, 9 with fungal sinusitis, and 5 with sphenoid sinusitis. Visual disturbances improved in 6 patients, and all the patients with diplopia had a postoperative recovery.ConclusionVisual disturbances resulting from ISSIDs are relatively uncommon, but it is crucial that the patient with new vision loss or diplopia and persistent headache or orbit pain be evaluated for the possibility of ISSIDs especially before corticosteroid administration.

Leber hereditary optic neuropathy: 41-year interval between fellow eye involvement

“…To date, the longest interval between affected eyes is 18 years. 4 We present a patient with an interval of 41 years. To our knowledge, this is the longest interval between fellow eye involvement in LHON to be reported in the English-language ophthalmic literature.…”

“…These 3 mutations account for 90%À95% of LHON cases. 4,5 The most common mutation is 11778. 5 While the peak age of onset for all cases is second and third decades of life, the average age of onset in the 11778 mutation is 22À24 years.…”

Tolosa Hunt Syndrome: Current Diagnostic Challenges and Treatment

“…Prompting for the associated features should follow after exhausting the presenting complains [39]. In the most recent retrospective case series regarding isolated sphenoid sinus inflammatory diseases involving 23 patients with new vision loss/diplopia and unremitting headache or painful orbit, it was observed that twenty out of the twenty three patients (87%) presented with pain (headache and ocular pain) with oculomotor and abducens nerve palsies similar to THS presentation, but associated symptoms of one sided ocular disturbance in the form of blurred vision in 65% of the cases, two-sided binocular diplopia in 47%, ptosis in 17% and proptosis in 4% of the cases with CT/MR confirmation for pathology was crucial to rule out THS [40]. Never the less associated history of rapid weight loss even without the history of smoking in a patient with headache, diplopia and CN palsies, should warn a physician for the possibilities of Guillain-Alajouanine-Garcin syndrome (Garcin syndrome) which is a metastatic tumor with bone destruction, therefore CT Scan should be ordered for confirmation of osteoblastic lesion in base of the skull [41].…”

Sphenoidal mucopyocele with visual impairment: case report of a rare disease and literature review

“…In our case, his periorbital pain improved following surgery, however, the vision remains static compared to the preoperative status. In the study performed by Chen et al (9) on 23 patients presenting with an isolated sphenoid sinus disease and visual disturbances such as reduced visual acuity and double vision, 6 had improvement following sphenoidotomy and clearance of the disease.…”