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Case Reports
. 2022 Jul 26;34(2):264-266.
doi: 10.4103/joco.joco_302_21. eCollection 2022 Apr-Jun.

Bilateral Vision Loss in an Adult Patient with Woakes' Syndrome: An Unprecedented Case

Kaveh Abri Aghdam  1 , Ali Aghajani  1   2 , Sara Hemmati  1 , Mostafa Soltan Sanjari  1
Affiliations
Case Reports

Bilateral Vision Loss in an Adult Patient with Woakes' Syndrome: An Unprecedented Case

Kaveh Abri Aghdam et al. J Curr Ophthalmol. .

Abstract

Purpose: To report a rare case of Woakes' syndrome presented with bilateral vision loss.

Methods: A 28-year-old male with a 1-year history of vision loss in the left eye was referred to the neuro-ophthalmology clinic after sudden vision loss in his right eye. A detailed review of clinical findings and the presumed pathophysiological basis of vision loss was performed.

Results: Neuroimaging revealed bilateral massive nasal polyps, sphenoid sinus mucocele formation, and optic nerve dehiscence inside the sphenoid sinus. The vision in the right eye was restored after pulse corticosteroid therapy; however, the left eye remained severely visually compromised even after nasal polypectomy and mucocele drainage.

Conclusion: Sinonasal disorders should be sought for patients with unexplained vision loss, as prompt intervention could be vision-saving in these patients.

Keywords: Sphenoid sinus mucocele; Vision loss; Woakes’ syndrome.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Facial, orbital, and paranasal sinus study. (a) The face photograph of the patient shows telecanthus and deformity of the nasal bridge (black arrow). (b) Coronal noncontrast T1-weighted magnetic resonance image of the orbits and paranasal sinuses reveals the remodeling of the medial orbital walls with an expansion of the ethmoid sinus (white arrow); note the hyperintense lesions that occupy the nasal cavity and the ethmoidal sinuses with expansion to the frontal sinuses. Maxillary sinus fullness with polypoidal lesions and mucocele formation is also notable (black asterisk). (c) Axial noncontrast computed tomography (CT) scan of the orbits depicts the destruction of the nasal pyramid and expansion of the ethmoidal sinuses toward the left orbit. (d) Axial noncontrast CT scan of the orbits and paranasal sinuses after endoscopic polypectomy shows the intact bony wall of the right optic canal through the sphenoid sinus
Figure 2
Figure 2
Optic nerve study. (a) Coronal contrast-enhanced T1-weighted magnetic resonance (MR) image shows the expansion of the sphenoid sinus and displacement of intracranial structures. The optic nerves are visible as they are passing through the sphenoid sinus (arrowheads). Polypoidal lesions are visible in both right (white arrow) and left sphenoid sinuses (surrounding the optic nerve). (b) Axial contrast-enhanced T1-weighted MR image demonstrates the fullness of the sphenoid sinus on the left side with direct contact of the optic nerve with mucocele material. Note the expansion of ethmoidal sinuses that are packed with contrast-enhanced lesions that are consistent with the diagnosis of intranasal polyps. (c) An optical coherence tomography scan of the peripapillary nerve fiber layer shows a significant loss of retinal nerve fiber layer in the left eye
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