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A 22 year old man presented with acute onset of loss of vision in the right eye of six hours’ duration. There were no associated complaints of pain or redness of eye. There was no associated convulsion or alteration in sensorium. He complained of a mild headache over the past two days. On examination the perception of light in the right eye was absent. Light and accommodation reflex testing revealed a right afferent abnormality. Funduscopy showed blurred disc margins and pallor of the right optic disc. Eye movements were normal and painless. There was no other focal neurological deficit.
A computed tomogram of the brain and paranasal sinus (fig 1) revealed a large mucocoele in the right sphenoidal sinus, with a defect in the lateral wall of the sinus. Optic nerve imaging with gadolinium enhanced magnetic resonance imaging (MRI, fig 2) confirmed the findings and did not reveal any optic nerve signal abnormality to suggest demyelination.
An emergency sinoscopy was performed and drainage of the mucocoele was done. The patient’s vision improved within one day postoperatively and there was no recurrence of the symptoms at follow up. Our case report highlights an unusual cause of acute painless mono-ocular vision loss. Acute blindness as a presentation of sphenoidal sinus mucocoele occurs very rarely. The common presentation of sphenoidal sinus mucocoele is diplopia, proptosis, Horner’s syndrome, multiple cranial palsies, and panhypopitutarism.