Supplementary Material for: Unilateral Painless Visual Loss in Sphenoid Mucoceles with Optic Neuropathy

Purpose: To present a case of optic neuropathy secondary to sphenoid sinus mucoceles (SSMs) manifesting as unilateral painless visual impairment.
Methods: Case report. A 67-year-old Asian female patient presented with a 7-day history of progressive visual impairment in her left eye.
Results: Best-corrected visual acuity (BCVA) was 20/20 in the right eye and limited to finger counting in the left eye with a relative afferent pupillary defect. The patient was initially diagnosed with retrobulbar ischemic optic neuropathy, and promptly treated with intravenous steroids, resulting in short-term improvement in BCVA. However, three months later, the patient experienced a more severe visual impairment in the left eye compared to the previous hospitalization, accompanied by left orbital pain and pulsatile headache localized to the left temporal region. Imaging studies, including CT and MRI of the paranasal sinuses, revealed a mass-like shadow in the bilateral sphenoid sinuses and posterior ethmoid sinuses. The patient was subsequently referred to the otolaryngology department for further evaluation. Following surgical intervention and histopathological examination, the patient was diagnosed with bilateral sphenoid sinus mucoceles (SSMs). One month postoperatively, BCVA in the left eye improved to 20/30, with complete resolution of all clinical symptoms.
Conclusion: Although visual disturbances secondary to SSMs are relatively uncommon, and instances of isolated unilateral or bilateral vision loss are particularly rare, it is crucial for ophthalmologists to be aware of the clinical features of this disease entity to prevent misdiagnosis and inappropriate treatment. Imaging studies such as CT or MRI scans are essential for accurate diagnosis.