Clinical features of visual disturbances secondary to isolated sphenoid sinus inflammatory diseases

Abstract

Background: Visual disturbances associated with isolated sphenoid sinus inflammatory diseases (ISSIDs) are easily misdiagnosed due to the nonspecific symptoms and undetectable anatomical location. The main objective of this retrospective case series is to investigate the clinical features of visual disturbances secondary to ISSIDs.

Methods: Clinical data of 23 patients with unilateral or bilateral visual disturbances secondary to ISSIDs from 2004 to 2014 with new symptoms were collected. Collected data including symptoms, signs, neuroimaging and pathologic diagnosis were analyzed.

Results: There were 14 males and 9 females, and their ages ranged from 31 to 83 years. Fifteen patients suffered blurred vision and 11 patients suffered binocular double vision, including 3 patients who had unilateral visual changes and diplopia simultaneously. Headache was observed in 18 patients, and orbit pain/ocular pain in 8 patients. Other presenting symptoms included ptosis (4 patients) and proptosis (1 patient). Only 5 patients had nasal complaints. The corrected visual acuities were between NLP to 20/20. Patients with diplopia included 5 with unilateral oculomotor nerve palsy and 6 with unilateral abducens nerve palsy. All patients performed orbital/sinus/brain radiologic examination and found responsible lesions in sphenoid sinus. All patients underwent endoscopic sinus surgery, and 9 patients were found to suffer sphenoid mucocele, 9 with fungal sinusitis, and 5 with sphenoid sinusitis. Visual disturbances improved in 6 patients, and all the patients with diplopia had a postoperative recovery.

Conclusion: Visual disturbances resulting from ISSIDs are relatively uncommon, but it is crucial that the patient with new vision loss or diplopia and persistent headache or orbit pain be evaluated for the possibility of ISSIDs especially before corticosteroid administration.

Keywords: Diplopia; Headache; Isolated sphenoid sinus inflammatory diseases; Visual disturbance.

Fig. 1

Decreased vision secondary to isolated sphenoid sinus inflammatory lesions. VA, Visual Acuity; NLP, No Light Perception; LP, Light Perception

Fig. 2

Decreased vision secondary to fungal sphenoid sinusitis. VA, Visual Acuity; NLP, No Light Perception; LP, Light Perception

Fig. 3

Case 5, male, 51y, sphenoid sinus mucocele (right, VA = 30/200). Neuroimaging showed a hemispherical abnormal mass rose from right sphenoid sinus with expansion to surrounding areas. There is extension into the right orbital apex and compression of the right optic nerve. a: Axial CT scan showing the expansile lesion. b: Axial, T2-weighted MRI scans with homogenous, fluid density lesion in the right sphenoid sinus. c: Coronal CT scan shows chronic bony expansion of the sinus. d: Coronal, T1-weighted, contrast-enhanced MRI scan demonstrating the fluid-filled lesion

Fig. 4

Neuroimaging for case 1, male, 47y, chronic sphenoid sinusitis (right, VA = 20/200). a: Axial computed tomography scan shows bony destruction at the right orbital apex. b: Axial, T2-weighted magnetic resonance imaging scan reveals a homogenous, hyperintense lesion of the inferior aspect of the right sphenoid sinus. c: Coronal computed tomography scan demonstrating erosion of the bony medial orbital apex. d: Coronal, T1-weighted, contrast-enhanced magnetic resonance imaging scan without contrast shows heterogenous signal in the right sphenoid sinus

Fig. 5

Neuroimaging for case 3, female, 56y, invasive fungal sphenoid sinusitis (right, VA = no light perception). a: Axial CT scan with expansion and opacification of the right optic canal and optic nerve, which was invaded by fungal organisms. b: Axial, T2-weighted MRI scan showing hypointense signal primarily adjacent to the right optic canal. c: Coronal CT scan showing opacification of the right anterior clinoid process. d: Coronal, T2-weighted, contrast-enhanced MRI scan with abnormal signal in the area of the right orbital apex