Prolonged visual disturbance secondary to isolated sphenoid sinus disease

OBJECTIVES/HYPOTHESIS: The objective was to evaluate the efficacy of endoscopic sinus surgery in patients with isolated sphenoid sinus disease with visual disturbances of more than 72 hours' duration. STUDY DESIGN: Retrospective review. METHODS: A sequential series of patients with isolated sphenoid sinus disease with visual disturbances who underwent endoscopic surgery performed by the same surgeon between 1995 and 2002 were reviewed. Patients with malignant tumors were excluded from the study. Patients were evaluated preoperatively and postoperatively to record the effects of this approach on visual acuity and diplopia. RESULTS: The study population included six women and seven men with a mean age of 56.2 years (age range, 31-75 y). Eight eyes had vision loss attributable to compressive optic neuropathy (27%) and optic neuritis (27%); seven eyes with diplopia had abducens palsy (40%) and oculomotor nerve palsy (7%). Sphenoid sinus lesions included sinusitis (38%), mucocele (31%), and aspergillosis (31%). The mean interval between the onset of visual disturbances and surgery was 6.6 months (range, 3 d-3.5 y). Visual disturbances improved in 60% of the patients (P <.01). There was better improvement in diplopia than in vision loss (P <.01). The results of endoscopic sinus surgery for patients with abducens palsy and aspergillosis were excellent (83% and 80%, respectively). Optic neuritis and visual disturbances lasting for more than 6 months were regarded as poor prognostic factors. CONCLUSION: The study supports the treatment of visual disturbances resulting from isolated sphenoid sinus disease by endoscopic sinus surgery. A timely operation may prevent permanent sequelae.