J Korean Ophthalmol Soc.  2020 Nov;61(11):1348-1357. 10.3341/jkos.2020.61.11.1348.

Clinical Characteristics of Rhinogenic Optic Neuropathy Associated with Paranasal Sinus Disease

• Chu M
• Park Y
• Shin SY
• Park SH

• KMID: 2511272
• DOI: http://doi.org/10.3341/jkos.2020.61.11.1348

Abstract

Purpose
We describe the clinical features of patients with rhinogenic optic neuropathy caused by paranasal sinus disease.
Methods
Nine patients (11 eyes) diagnosed with rhinogenic optic neuropathy were retrospectively reviewed. All exhibited sphenoid or posterior ethmoid sinus lesions on magnetic resonance imaging and corresponding visual acuity or visual field defects. Patients with other causes of optic neuropathy were excluded. We recorded symptoms and symptom durations, best-corrected visual acuity, relative afferent pupillary defects, color vision test results, fundus morphology, optical coherence tomographic data, and visual field test results before and after endoscopic sinus surgery.
Results
The involved sinuses were the sphenoid alone (five eyes), posterior ethmoid alone (two eyes), and both (four eyes). The underlying sinus pathologies included six eyes with sinusitis and three with mucoceles. The best-corrected visual acuity exceeded 20/40 for nine eyes, the color vision test results were normal for all eyes, and relative afferent pupillary defects were noted in three eyes of unilaterally affected patients. The Humphrey visual field test revealed paracentral scotomas (three eyes, 27.3%), nasal defects related to the vertical meridian (three eyes, 27.3%), arcuate defects (two eyes, 18.2%), and a horizontal altitudinal defect (one eye, 9.1%). Six patients underwent endoscopic sinus surgery. Three patients who underwent early interventions (within 4 weeks of onset) experienced full visual recovery.
Conclusions
In patients with suspected optic neuropathy, a paranasal sinus lesion adjacent to the optic canal should be considered. Prompt diagnosis and early intervention (endoscopic sinus surgery) are recommended for patients with rhinogenic optic neuropathy to reduce the incidences of visual loss and visual field defects.

Keyword

Optic neuropathy; Paranasal sinus disease; Visual field