Images in Clinical Medicine
Ethmoid Mucocele Causing Visual Impairment
N Engl J Med 2008; 358:2495June 5, 2008
- Article
A 74-year-old man was referred because of left exophthalmos and outward displacement of the orbit (Panel A). His symptoms had progressed slowly over a 4-year period but had worsened rapidly during the preceding 2 days, causing diplopia, impaired ocular movement, orbital pain, and decreased visual acuity (0.8 in the right eye and 0.2 in the left eye, corresponding to Snellen equivalents of 20/25 and 20/100, respectively). On computed tomography, a cystic lesion was observed in the left ethmoid sinus (Panel B), where it was compressing the globe (white arrow) and eroding the lamina papyracea (black arrows) and part of the skull base (white arrowhead). Since the patient's ocular symptoms had acutely worsened, he underwent immediate surgery because of a concern about superinfection of a mucocele. Septoplasty and endoscopic marsupialization were performed, and yellowish fluid was evacuated without complications. Postoperatively, his ocular symptoms improved immediately, with a visual acuity of 0.7 (Snellen equivalent, approximately 20/30) in the left eye. The patient remained asymptomatic 2 months after surgery.
Jae Yong Lee, M.D., Ph.D.
Soonchunhyang University Bucheon Hospital, Bucheon 420-767, Korea
jyent@schbc.ac. kr
