Optic nerve involvement in posterior paranasal sinus diseases

Abstract

During a 13-year period, we encountered 18 cases of involvement by posterior paranasal sinus diseases in patients with optic neuritis. These could be divided into two groups, a mucocele and pyocele group (nine cases) and a sinusitis group (nine cases), both with the following clinical profile: The chief complaint was decreased vision, prodromal symptoms were noticed in a few cases, the visual field showing central or paracentral scotoma in almost all cases. Recurrence of visual disturbance was obscured in all patients in the mucocele and pyocele group; several cases resembled multiple sclerosis, but could be distinguished from this disease after thorough neuro-ophthalmological examination and by long-term absence of neurological signs and symptoms after nasal surgery. CSF examination showed that inflammatory changes occurred in some patients in the sinusitis group. Although there is general agreement at present that a major cause of optic neuritis is demyelination, posterior paranasal diseases should also be considered as important agents in the pathogenesis of the optic disorder.

Key Words:

• optic neuritis
• posterior ethmoidal sinus
• sphenoidal sinus
• sinusitis
• mucocele
• pyocele
• multiple sclerosis