Mucositis of paranasal sinus with temporary amaurosis
M. Lüchtenberg, A. Mikowski, S. Antal, J. Bühren, O. E. Schnaudigel, R. Schalnus
Case report: : A 29-year-old patient was presented to our clinics with an acute reduction of visual acuity of the right eye. The patient reported a total loss of vision since seven days, alcohol and nicotine excess walked ahead. The patient was used to large quantities of alcohol and nicotine.
The clinical examination showed inconspicuous slid-lamp findings, only a mydriasis of the right eye.
The right optic nerve showed a slight boundary unsharpness nasal superior, the visual acuity was in the right eye no light and in the left eye 12/12. The light-reaction of the right eye was direct sluggish, indirect prompt. The visual field of the right wasn`t measurable, on the left unobtrusive. The pattern- and flash VEP of the right eye wasn`t reproducable as a hint to a trouble of the retinocortical conduction-system.
Under the suspicious diagnosis of an ischaemia of the optic nerve, induced by tabac and alcohol, the patient was admitted and a haemodilution- and steroid-therapy was started. No improvement was seen. Next day the CT scan of the brain and orbits showed a chronic inflammatory reaction of the mucosa of the maxillary and ethmoidal sinus on the right The tumor was connected via a bone-defect with the optic canal; there was a compression of the optic nerve. An endonasal tumor-resection followed with optic nerve-decompression. The histology confirmed the diagnosis of a mucositis of the respiratory mucosa with ciliated epithelium and edema of slack lamina propria. One week postoperative an improvement of the visual acuity of the right eye to defect light-projection was seen, but also an early atrophy of the optic disc.
Conclusion: Carrying-out an imaging procedure in cases of unclear loss of visual acuity should always be taken into consideration to exclude an tumor induced compression, in spite of the period of cost-consciousness.
Augenklinik, Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, D -60590 Frankfurt/Main