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Case Reports
. 2021 Jul 5;33(2):197-200.
doi: 10.4103/2452-2325.288940. eCollection 2021 Apr-Jun.

Bilateral Visual Loss Caused by Pneumosinus Dilatans: Idiopathic Cases are not Always Reversible

Kaveh Abri Aghdam  1 , Ali Aghajani  1 , Mostafa Soltan Sanjari  1
Affiliations
Case Reports

Bilateral Visual Loss Caused by Pneumosinus Dilatans: Idiopathic Cases are not Always Reversible

Kaveh Abri Aghdam et al. J Curr Ophthalmol. .

Abstract

Purpose: To report a rare case of primary pneumosinus dilatans (PSD) and to specify the cardinal imaging findings associated with this condition.

Methods: A 20-year-old patient presented with bilateral profound visual loss as a result of primary PSD. A detailed review of clinical findings and presumed pathophysiological basis of vision loss was performed.

Results: Other than undiagnosed primary hypothyroidism, no other abnormalities were found. With the diagnosis of PSD, the patient underwent optic nerve decompression through transnasal sphenoidotomy. However, after nine months of follow-up, no improvement in the patient's vision was attained.

Conclusion: Unlike previous reports of favorable visual results after sphenoidotomy and bilateral decompression of the optic nerves, vision recovery was not achieved in this case.

Keywords: Optic atrophy; Paranasal sinus; Pneumosinus dilatans.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The color fundus photographs of the right (a) and left (b) eyes of the patient show bilateral optic atrophy increased cupping of the right optic disc. Peripapillary circular optical coherence tomography scans show greater than expected retinal nerve fiber layer loss in both eyes (c). The central 10-2 visual field testing of the left (d) and right (e) eye shows severely damaged visual fields in both eyes
Figure 2
Figure 2
The lateral skull radiograph shows prominent pneumatization of frontal sinuses (a), axial computerized tomography (CT) images render massive expansion of ethmoid (b), and frontal (c) sinuses. Expansion of frontal and ethmoid sinuses is visible in coronal (d) and expansion of sphenoid sinuses in sagittal CT scan images (e)
Figure 3
Figure 3
Coronal computerized tomography bone window images depict optic canal narrowing and protrusion of the optic nerve into the sphenoid sinus (black arrows). Note the pneumatization of posterior clinoid processes (panel A). Axial brain magnetic resonance imaging scans with contrast reveal the intracranial portion of the left optic nerve in close contact with the air in the sphenoid sinus (white arrows) (panel B)
See this image and copyright information in PMC

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