Reversible blindness secondary to acute sphenoid sinusitis

Abstract

Sphenoid sinusitis is an elusive diagnosis with significant morbidity if not diagnosed and treated promptly. We have reported an unusual case of acute sphenoiditis mimicking Gradenigo's syndrome. This resulted in virtual bilateral blindness that entirely resolved with aggressive surgical and medical treatment. It is recommended that sphenoid sinusitis be strongly considered in patients with acute headache and fever. A detailed cranial nerve examination should be performed, and CT scans of the skull base and paranasal sinuses should be obtained. Immediate surgery is strongly recommended for acute sphenoid sinusitis at the first suggestion of a complication and in those patients not promptly responding to medical therapy. It is apparent that irreversible damage to the optic nerve can occur before the development of gross intraorbital pathology. Therefore we believe that delaying surgery until the visual acuity is worse than 20/60, as advocated by some authors, may not be in the patient's best interest. Surgery should be directed at removing the purulent material, obtaining cultures, removing irreversibly diseased mucosa, and maintaining drainage of the sphenoid sinus.

Isolated Sphenoid Sinus Diseases

“…1,5,9,10 Experimental stimulation of the sphenoid sinus results in pain at the vertex. 11 In sphenoiditis, vertex headache is common, but pain can be localized in frontal, temporal, periorbital, or occipital regions or can be vague or occur anywhere in the craniofacial region. 1,3,5,7,11,12 Visual changes indicating imminent complications are common, being encountered in up to 70% of patients with inflammatory sphenoid disease.…”

“…11 In sphenoiditis, vertex headache is common, but pain can be localized in frontal, temporal, periorbital, or occipital regions or can be vague or occur anywhere in the craniofacial region. 1,3,5,7,11,12 Visual changes indicating imminent complications are common, being encountered in up to 70% of patients with inflammatory sphenoid disease. [6][7][8]13 Trigeminal nerve symptoms have been reported in 10% to 30% of inflammatory diseases, and cranial nerve findings have been reported in 12% to 70% of cases.…”

Komplikationen bei entz�ndlichen Erkrankungen der Nasennebenh�hlen

“…Eine sofortige operative Therapieindikation ergibt sich selbstverständlich bei klinisch akuter Symptomatik und plötzlich akut aufgetretener Erblindung [47]. Aufgrund der interdisziplinären Bearbeitung des Kommentars durch Juristen, Mediziner und Sozialwissenschaftler werden die mit dem Transplantationswesen verbundenen Probleme ausführlich besprochen.In einem umfangreichen Materialteil (Teil D) werden außer-dem die Richtlinien der Bundesärztekammer zur Organvermittlung, zu Wartelisten und zu Maßnahmen der Qualitätssicherung bei verschiedenen Organsystemen abgehandelt.…”

Self-inserted Sphenoid Sinus Foreign Bodies

“…Optic neuritis, orbital osteomyelitis, blindness, cavernous sinus thrombophlebitis, and intracranial abscesses are relatively uncommon but may develop if an acute or chronic sphenoid sinusitis is left untreated for an extended period. [8][9][10][11] For this reason, any sphenoid sinus foreign body should be removed when discovered if the general medical status of the patient so allows.…”