Recurrent Optic Perineuritis after Intranasal Cocaine Abuse

Abstract

Recurrent optic perineuritis can be related to orbital inflammation. Here we present the case of a 46-year-old male patient in whom recurrent episodes of optic perineuritis were related to chronic osteolytic sinusitis following intranasal cocaine abuse. Magnetic resonance imaging (MRI) demonstrated optic perineuritis adjacent to a soft tissue mass that intruded the orbit from the nasal cavity. Computed tomography (CT) confirmed destruction of the medial orbital wall. Staphylococcus aureus was cultured and biopsy showed granulomatous tissue. Visual outcome was poor. We review the literature and discuss the diagnostic pitfalls and management implications in relation to optic (peri)neuritis originating from the nasal sinuses.

• Cocaine
• CT
• histology
• MRI
• optic neuritis
• optic perineuritis
• osteolytic sinusitis

Acknowledgements

We thank Dr. W. Swart who at viewing our case presentation at the Dutch ophthalmology meeting (21 April 2013) pointed out that this patient was seen 5 years earlier at a different Dutch hospital for a similar problem. We also thank Dr. M. Lavaei for the histology picture.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Note: Figure 3 of this article is available in colour online at www.informahealthcare.com/oph