Visual prognosis in compressive optic neuropathy secondary to sphenoid sinus mucocele: A systematic review

Abstract

Sphenoid sinus mucoceles (SSMs) are rare, benign lesions that can expand, often presenting with ocular symptoms-decreased vision, diplopia, visual field defects, proptosis, and external ophthalmoplegia. Reported cases are few, visual compromise varies, and factors affecting visual prognosis are poorly characterized. We investigate whether prompt surgical intervention (within 2 weeks of visual symptom onset) affects best-corrected visual acuity (BCVA) regained in patients with vision loss secondary to compressive SSM. We present a retrospective review of three cases and published literature to date. Our primary outcome was BCVA regained after surgical intervention; secondary outcomes included change in visual field defect and ophthalmological symptoms other than vision loss. Our three cases of SSM varied in onset, ranging from several hours to several months with patients aged from 13 to 80 years. All patients had severe vision loss to light perception (LP) or worse. Rapid neuro-imaging and urgent surgical intervention improved vision to count fingers at best. Of the two patients who underwent prompt decompression, one improved from no LP to LP and the other did not recover any vision. The patient who had visual loss for 3 months before intervention improved from LP to 20/400. Findings from our literature search, which yielded 12 cases of urgent intervention, supported the variability in visual prognosis despite prompt surgical intervention. SSMs are rare, pathologically benign lesions which can expand to cause ocular involvement. Prompt diagnosis and surgical decompression are recommended, but visual recovery may be limited even with urgent intervention.

Clinical Analysis of Sphenoid Sinus Mucocele With Initial Neurological Symptoms

“…Headaches can be classified as either primary (such as migraine, tension, or cluster headaches) or secondary to other pathology. The sphenoid sinus lies in close proximity to important anatomic structures, including the cavernous sinus, the internal carotid artery, pituitary gland, the optic nerve and other cranial nerves (oculomotor, trochlear, trigeminal, and abducent nerves), and a variety of pathologies affecting these structures may lead to secondary headaches . Headache is often the initial or only symptom of a sphenoid sinus cyst.…”

A Fronto-ethmoidal Sinus Mucocele presenting with optic disc edema

“…Paranasal sinus mucoceles extend progressively to the orbit due to continuous production and accumulation of mucus, and may cause variable ophthalmological manifestations depending on its location, the size of the mucocele, the involvement of adjacent tissues and direction of expansion [1] . The frontal and anterior ethmoid sinus mucoceles tend to cause proptosis, diplopia, displacement of the eyeball, mass in the inner canthus, lid swelling, and increased intraocular pressure due to the compression exerted on the eye, whereas the posterior ethmoid and sphenoid mucoceles are close to the III, IV, V, VI cranial and optic nerves, and more commonly lead to visual disturbance and orbital apex syndrome [5] .…”

Disminución de agudeza visual, hipertelorismo y exoftalmos debido a piomucocele bilateral

“…La disminución de la agudeza visual izquierda fue debido, probablemente, al efecto compresivo y gradual del mucocele esfenoidal en el canal óptico, produciendo una inflamación secundaria, facilitado por el menor suministro vascular (10) existente a dicho nivel . La presencia de mucoceles, a pesar de su naturaleza benigna, justifica una evaluación oftalmológica que facilite información de las conductas médicas o quirúrgicas a seguir.…”