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Recurrent Optic Perineuritis after Intranasal Cocaine Abuse.

S Coppens1, A Petzold1, P de Graaf1

  • 1VU University Medical Center Amsterdam The Netherlands.

Neuro-Ophthalmology (Aeolus Press)
|December 9, 2016
PubMed
Summary

Recurrent optic perineuritis, an orbital inflammation, can stem from chronic sinusitis due to intranasal cocaine abuse. This case highlights the link between sinusitis and optic nerve inflammation, impacting vision.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Otolaryngology

Background:

  • Optic perineuritis is an inflammatory condition affecting the optic nerve sheath.
  • It can be associated with various orbital and systemic inflammatory processes.
  • Nasal and sinus pathologies are infrequently recognized causes.

Observation:

  • A 46-year-old male presented with recurrent optic perineuritis.
  • Imaging revealed optic nerve inflammation adjacent to a mass invading the orbit from the nasal cavity.
  • This was associated with chronic osteolytic sinusitis secondary to intranasal cocaine abuse.

Findings:

  • Computed tomography (CT) confirmed medial orbital wall destruction.
  • Biopsy revealed granulomatous tissue with Staphylococcus aureus cultured.
Keywords:
CTCocaineMRIhistologyoptic neuritisoptic perineuritisosteolytic sinusitis

Related Experiment Videos

  • The patient experienced a poor visual outcome.

    • Implications:

    • This case underscores the importance of considering sinonasal disease in cases of unexplained optic perineuritis.
    • Diagnostic challenges include differentiating primary orbital inflammation from sinogenic causes.
    • Management requires a multidisciplinary approach addressing both the sinusitis and the optic nerve inflammation.