Compressive optic neuropathy due to posterior ethmoid mucocele

Abstract

Mucoceles are cystic formations characterized by the presence of mucus-secreting epithelial cells, which enlarge when the excretory duct becomes obstructed. Posterior ethmoidal mucoceles are rare conditions that can lead to severe ocular complications requiring immediate intervention. The close anatomical proximity of posterior ethmoidal mucoceles to the optic nerve underscores their significance. In this case report, we present a case of rapidly progressing compressive optic neuropathy secondary to a posterior ethmoidal mucocele. A previously healthy forty-six-year-old woman presented with sudden visual loss in her left eye, preceded by left-sided headache and periorbital pain. Clinical examination and imaging studies revealed an oval-shaped mass within the posterior ethmoid cell compressing the left optic nerve. Emergency surgery was performed to alleviate optic nerve compression, which successfully relieved periocular pain. However, the patient's visual acuity and visual field defect remained unchanged postoperatively. Thinning of the ganglion cell layer in the macula region was observed during follow-up examinations. The role of corticosteroids and antibiotics in visual rehabilitation and the impact of delayed surgical decompression on visual outcome remain subjects of debate. Additional cases of mucocele-associated optic neuropathy should be published and analyzed to establish optimal treatment approaches.

Keywords: Acute visual loss; Compressive optic neuropathy; Mucocele; Posterior ethmoid cell.

Fig. 1

Preoperative Brain Magnetic Resonance Imaging (MRI) and Paranasal Sinus Computed Tomography (CT). (A, B) Preoperative brain MRI shows mass on the ethmoidal sinus, with intermediate signal on T1 image (A) and intermediate to low signal intensity on T2 FLAIR image (B). (C, D) Preoperative paranasal sinus CT. (C) Axial scan shows total opacification on the left ethmoidal cell. (D) Coronal scan shows prominent dehiscence of canal wall (arrowheads)

Fig. 2

Postoperative Ophthalmic Findings. (A) optical coherence tomography of right eye (unaffected side). (B) optical coherence tomography of left eye (affected side) 3 weeks after surgery. Severe progression of ganglion cell layer thinning was noted. (C) Initial and (D) final visual field examination. Humphery visual field of the left eye showed significant constriction of the visual field