Optic neuritis caused by mucocele of paranasal sinuses – a casual link or a coincidence? A case study

Overview

Extension of inflammation into the orbit in acute and chronic sinusitis is not a rare situation, as a result of the close anatomical vicinity of the orbit and paranasal sinuses (PS). Also well documented are cases of damage to the optic nerve during endoscopic surgery of the paranasal sinuses. However, opinions still diverge on the possibility of optic neuritis developing in pathological processes in the posterior ethmoid and sphenoid sinuses region. The possibility of retrobulbar neuritis developing in paranasal sinus mucoceles and pyoceles has been a recurrent topic of discussion in the relevant literature. Mucocele is a cystic, slow-growing lesion of paranasal sinuses with sterile content; pyocele contains purulent secretion and is created by secondary bacterial infection of a mucocele. The article describes a case study of a patient with sudden loss of right vision in retrobulbar neuritis. The disease was probably linked with a posterior ethmoid and right sphenoid sinus mucocele. Based on the patient's clinical condition and a CT image, endoscopic endonasal surgery of the paranasal sinuses was indicated. Post-surgical therapy included general corticoids and antibiotics, yet the patient's vision did not improve. Permanent damage to the patient's vision is likely to have been caused by the time which elapsed from the loss of vision to adequate surgical treatment, i.e. more than 24 hours. Possible causes of nervous affection are discussed, including destruction of the optic canal and compression of the nerve by the pressure of the mucocele, transition of infection in the case of pyocele, or the development of occlusive vasculitis with subsequent ischemic changes.

Key words:
mucocele of lateral nasal cavities – retrobulbar neuritis – optical nerve neuropathy – functional endocsopic surgery – FESS