Sudden Unilateral Visual Loss Due to an Onodi Cell Mucocele

Area of Science:

• Ophthalmology
• Otorhinolaryngology
• Neurology

Background:

• Sudden vision loss following sinus surgery can be linked to optic nerve compromise.
• Compressive mucoceles, particularly in Onodi cells with orbital apex bony dehiscence, pose a risk to the optic nerve.

Purpose of the Study:

• To report a case of sudden vision loss secondary to an Onodi cell mucocele.
• To discuss the diagnostic and therapeutic challenges in managing compressive ischemic optic neuropathy.

Main Methods:

• A case report of a 41-year-old male with a history of sinus surgery presenting with sudden vision loss.
• Computed tomography (CT) identified an Onodi cell mucocele with orbital apex dehiscence.
• Endoscopy-assisted endonasal marsupialization and high-dose intravenous dexamethasone were administered.

Main Results:

• The patient experienced a slight improvement in visual acuity post-surgery (from hand motions to counting fingers).
• Further visual recovery was not observed despite successful mucocele decompression.
• Pathology confirmed inflamed nasal mucosa consistent with a mucocele.

Conclusions:

• Onodi cell mucoceles, especially with orbital apex bony dehiscence, can cause direct optic nerve insult.
• Visual recovery in compressive ischemic optic neuropathy from mucoceles is often limited, even with prompt intervention.