An interesting case report of delayed presentation of visual loss from an Ethmoid Mucocoele. Should we offer emergency decompression?. (April 2021)

• Record Type: Journal Article
• Authors: Raithatha, Amit; Coyle, Paula; Talwar, Rishi; Dias, Andrew
• Is Part Of: International journal of surgery case reports. Volume 81(2021)
• Publication Date: 2021-04
• Subjects: Ethmoid mucocoele -- Emergency endoscopic sinus surgery -- Optic nerve compression -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105744
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Consider rhinological causes for unilateral vision disturbances or loss. Consider emergency flexible nasendoscopy and imaging to identify sinonasal disease. Consider emergency endoscopic intervention in compressive Optic neuropathy. Communicate frankly with patients about the chances of success and complications. Pre-operative bedside assessment of vision is recommended at the minimum. Abstract: Paranasal sinus mucocoeles commonly involve the frontoethmoidal sinuses and can rarely present with vision changes due to expansion and invasion through the orbit. A 50-year-old female presented out of hours with an acute, 16-h history of complete left sided visual loss, on a background of 3 days of visual changes. A left ethmoid mucocoele extending into the left orbital apex causing compression of the optic nerve was diagnosed on imaging. Emergency endoscopic sinus surgery with decompression and marsupialization of the ethmoid mucocoele was performed, which resulted in improvement of vision. This case is unusual due to improvement in vision despite the length of visual loss prior to surgical intervention. This case demonstrates the importance of considering rhinological causes for vision loss, and how critical early identification and surgical intervention can be to prevent serious complications such as permanent vision loss.