Ocular presentation of sphenoid mucocele

Abstract

A sphenoid mucocele often presents late due to its deep-seated anatomical site. It has a varied presentation, due to its close relationship to the cavernous sinus and the base of the skull. It can present initially to the ophthalmologist with ocular complaints. In the present paper, the authors present two cases of sphenoid mucocele, one with an isolated third and one with an isolated sixth cranial nerve palsy.

A sphenoid sinus mucocele simulating as retro bulbar optic neuritis

“…[2] Sphenoid sinus mucoceles are relatively rare, representing 1% of all paranasal sinus mucoceles. [34] They usually start unilaterally, but by the time of presentation, the entire sphenoid sinus complex may be opacified and expanded with thinning of its bony walls. Cranial neuropathies are a feature in as many as 50% of cases.…”

Anterior clinoidal mucocele causing optic neuropathy: resolution with nonsurgical therapy

“…Due to the proximity of the anterior clinoid process to the optic nerve, patients with mucoceles in this location often present with ocular symptoms, including optic neuropathy, visual field defects, or blindness. 4 In contrast, patients with mucoceles of the sphenoid sinus often present with unilateral abducens palsy resulting in diplopia or oculomotor palsy resulting in ptosis due to the anatomical relationship between the sphenoid sinus and the cavernous sinus. 4 The onset of these varied ocular symptoms can be associated with sinus inflammatory disease including a clinical history of chronic sinusitis, allergic rhinitis, and/or previous sinus surgery.…”

“…4 In contrast, patients with mucoceles of the sphenoid sinus often present with unilateral abducens palsy resulting in diplopia or oculomotor palsy resulting in ptosis due to the anatomical relationship between the sphenoid sinus and the cavernous sinus. 4 The onset of these varied ocular symptoms can be associated with sinus inflammatory disease including a clinical history of chronic sinusitis, allergic rhinitis, and/or previous sinus surgery. 3 Mucoceles occurring in the sphenoid sinus (including those of the anterior clinoid process) account for only about 1% of paranasal sinus mucoceles, making them rare, although significant, occurrences.…”

Optic Neuropathy From Bacteria

“…Sphenoid sinus mucoceles are relatively rare, representing 1% of all paranasal sinus mucoceles. 83,84 They usually start unilaterally, but by the time of presentation, the entire sphenoid sinus complex may be opacified and expanded with thinning of its bony walls. Cranial neuropathies are a feature in as many as 50% of cases.…”

“…85 Compression of the cavernous sinus may cause exophthalmos and periocular pain. 82,83,[86][87][88] The third cranial nerve is the most commonly involved 85 ; with involvement or sparing of pupil function. 87 Frontal sinus mucocele has also been reported to cause ophthalmoparesis by extension into the orbit from above.…”