Compressive Optic Neuropathy due to a Large Onodi Air Cell: A Case Report and Literature Review

Abstract

Background:To report an unusual case of compressive optic neuropathy secondary to a large onodi air cell.Method:Case report.Results:A 50 year-old gentlemen presented to the eye clinic with left eye painless loss of vision for one day. Visual acuity was counting finger in the left eye with a positive relative afferent pupillary defect (RAPD). Dilated left fundus examination revealed a pale optic disc. A computed tomography of orbit and brain showed a large left sphenoid sinus with onodi-cell-like projection on the left superior margin of left optic canal impinging on the left optic nerve. He was referred to the otorhinolaryngology team and subsequently underwent left optic nerve decompression. Post-operatively, his left visual acuity improved to 6/60 with reversal of RAPD.Conclusion:There are many causes of optic neuropathy and compressive optic neuropathy due to large onodi air cell is uncommon. Acute unilateral loss of vision heralds from a multitude of sinister causes and junior residents should be vigilant that onodi air cell pneumotisation could be one of them.

Sphenoethmoidal air cell sinusitis: A rare cause of recurrent optic neuritis

“…In patients with symptoms lasting longer than one month whose CTs demonstrate compressive optic neuropathy due to a Onodi cell mucocele, the most favored treatment is surgical decompression with adjuvant corticosteroid. 16 , 17 In our case, there was no compressive lesion, and conservative management with antibiotic therapy likely led to decreased inflammation within the Onodi cell and optic nerve sheath within the adjacent optic canal.…”

Organized hematoma of the sphenoid sinus causing acute visual loss

“…In this case, visual deterioration occurred suddenly and progressed rapidly despite visual loss, which did not result from trauma but from a tumorous condition. Although there is no standardized time for intervention from the symptom onset of compressive optic neuropathy, previous reports have recommended that decompression should be performed within 24 h. 10 Because our patient exhibited abnormalities of hematological and coagulation profiles, the surgery was delayed and the vision was not recovered.…”