Optic Neuropathy due to an Ethmoid Mucocele: A Case Report and Literature Review

Abstract

Mucoceles of the paranasal sinus commonly involve the frontal sinuses, the ethmoid sinuses, and rarely the maxillary or sphenoid sinuses. They often present with sinus pain or pressure, but rarely can present with more severe symptoms such as changes in mental status or vision due to expansion and invasion through the skull base or orbit. A 62-year-old male presented with optic neuropathy, a relative afferent pupillary defect with proptosis and lateral gaze palsy of the left eye. The patient was found to have a large mucocele extending from the left posterior ethmoid sinus into the left orbital apex. Urgent endoscopic sinus surgery was performed jointly between Oculoplastics and Otolaryngology. Post-operatively, the patient had improvement in diplopia, extraocular motion, and proptosis with stable vision. This case demonstrates the importance of early identification and intervention in a rare presentation of a sinus mucocele to prevent serious complications such as vision loss.

Secondary optic neuropathy due to sphenoid-ethmoidal sinus mucocele

“…The most prevalent intracranial pathologies that can lead to optic neuropathies are lesions in the sellar and parasellar areas such as pituitary tumors, meningiomas, craniopharyngiomas, and intracerebral lesions affecting the visual pathways, as well as primary or secondary hydrocephalus. In addition to numerous main ophthalmologic illnesses [3], rhinogenic optic neuritis may also be induced by sphenoid sinus mucocele with sinusitis, ethmoiditis, and onodi cell inflammation [4][5][6][7].…”