Orbital Apex Mucocele Causing Sudden and Complete Blindness: Case Report and Review of the Literature

Introduction: Mucoceles of the paranasal sinuses are common, particularly after trauma or surgery, but they rarely occur in the posterior ethmoid cells. There, they may expand and cause external compression of adjacent structures including the optic nerve.

Case Report: A 32-year old man with a remote history of extensive allergic fungal sinusitis requiring sinus surgery including osteoplastic flap presented with sudden onset and complete blindness in one eye. Imaging showed posterior ethmoid mucoceles compressing the optic nerve at the orbital apex. Despite emergent and maximal treatment via endoscopic and open approaches, no improvement in vision was achieved.

Discussion: Compressive optic neuropathy resulting in complete visual loss is a poor prognostic factor in visual recovery. Patients who present with decreased visual acuity resulting from mucocele expansion may recover vision following endoscopic decompression. However, complete visual loss at initial presentation in this case of extensive disease resulted in permanent blindness despite maximal surgical management.