J Korean Ophthalmol Soc.  2007 Dec;48(12):1742-1746.

A Case of Optic Neuritis in Acute Sphenoid Sinusitis

• Jang JH
• Kim YC
• Chang SD
• Lee SY
• Kim KS

Abstract

PURPOSE: We encountered a rare case of optic neuritis that developed in a sphenoid sinusitis. This case has not been reported at any of the Korean Ophthalmological Society meetings.
CASE SUMMARY
A 12-year-old boy with swollen optic disc was diagnosed with optic neuritis secondary to sphenoid sinusitis, through orbit MRI (magnetic resonance imaging) and paranasal sinus CT (computed tomography). We observed the recovery of visual acuity and the improvement of papilledema after treatment. In the initial examination, the BCVA (best-corrected visual acuity) of the right eye was only hand movement. Papilledema was detected by ophthalmoscopy. Orbit MRI and paranasal sinus CT were then performed, which revealed that sphenoid sinusitis had invaded the right optic nerve. Treatment included the use of antibiotics, systemic steroid therapy, and endoscopic sinus surgery. One month after treatment, the BCVA of the right eye was 1.0 and the papilla of right eye had a normal ophthalmoscopic finding.
CONCLUSIONS
Sphenoid sinusitis can be a cause of optic neuritis. The treatment of optic neuritis caused by paranasal sinusitis must include antibiotics use or endoscopic sinus surgery to remove the sinus inflammation as well as high dose steroid therapy.

Keyword

Endoscopic sinus surgery; Optic neuritis; Sphenoid sinusitis

MeSH Terms

Anti-Bacterial Agents
Child
Hand
Humans
Inflammation
Magnetic Resonance Imaging
Male
Ophthalmoscopy
Optic Nerve
Optic Neuritis*
Orbit
Papilledema
Sinusitis
Sphenoid Sinus*
Sphenoid Sinusitis*
Visual Acuity
Anti-Bacterial Agents

Figure

• 

  Figure 1. Optic disc on ophthalmoscopy. (A) Swollen optic disc due to optic neuritis before treatment, (B) Clear optic disc margin after endoscopic sinus surgery.

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  Figure 2. Preoperative paranasal sinus dynamic CT. The image shows low density of soft tissue lesion in the sphenoid sinus, and there is no bony erosion or destruction of the walls of the sphenoid sinus (axial view).

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  Figure 3. Preoperative orbit MRI scan (T2W1 image). (A) The sphenoid sinus is filled with high signal enhancement lesion (coronal view), (B) The image shows diffuse linear enhancement of the right optic nerve in the intraorbital and orbital apex region (axial view).

Reference

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