Unilateral blindness secondary to acute sphenoid sinusitis

To highlight a rare scenario where a delay in diagnosis caused unilateral blindness.

A 45-year-old Aboriginal woman with a history of non-Hodgkin's lymphoma presented with a severe left-sided headache, pyrexia and positive blood cultures. Following admission, the patient rapidly developed unilateral blindness, but did not inform her physician until 21 hours after onset. High-resolution CT scanning of the sinuses showed erosion of the bony covering of the optic nerve. Sinus surgery was performed.

Despite the discovery of pus under considerable pressure, and clearing the sphenoid sinus of pus and debris, vision was not restored, even at 2-month follow-up.

Two pathological processes are postulated here: that erosion of the bony optic canal allowed the optic nerve to be exposed, allowing the ensuing sinusitis to cause irreversible nerve ischemia, and immunosuppression meant the patient's immune response was inadequate to cope with the sinusitis, with devastating effects.