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Optic Neuropathy: Endoscopic Optic Nerve Decompression for the Treatment of Rhinogenous Optic Neuritis

Netto Alice

Purpose: Rhinogenic optic neuropathy is a clinical term used for optic neuritis or neuropathy caused by paranasal cysts or mucocele. Optic neuropathy associated with sphenoid sinus mucocele is usually associated with poor prognosis. The prognosis in all these cases depends upon visual acuity at presentation and duration of disease. Delay in surgery in all such cases leads to extremely poor visual outcome. We herewith report a rare case of rhinogenic optic neuropathy that presented with complete loss of vision and had partial recovery of vision even after surgery being delayed for almost 3 weeks. The patient age, sex, preoperative and postoperative visual acuity, duration from visual deficit to surgery, use of steroids, type of rhinogenic optic neuropathy, and the part of sinus lesion were analyzed. We also examined postoperative visual acuity for patients whose preoperative visual acuity was less than light perception.

Results: The type of optic neuropathy was sinusitis in 7 cases, mucocele in 5 cases, and pyocele in 3 cases. Visual acuity was improved in 9 cases and deteriorated or unchanged in 6 cases. Patients in the improvement group were significantly younger than those in the nonimprovement group. In univariate regression analysis, preoperative visual acuity and type of optic neuropathy significantly related to postoperative visual acuity. Finally, 4 of the 15 cases (27%) had preoperative visual acuity less than light perception, but there was an improvement in postoperative visual acuity in 2 of 4 cases (50%).

Conclusions: Preoperative visual acuity is the predictive factor for postoperative visual acuity in patients with rhinogenic optic neuropathy, but even if the preoperative visual acuity is less than light perception, it can be improved by surgical treatment.