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Sphenoethmoidal Mucocele Presenting with Bilateral Visual Compromise

A 58-year-old woman presented with a 3-year history of right eye blindness and a progressive loss of visual acuity in the left eye over the previous 6 weeks. The patient had undergone evaluation at another institution when she lost vision in her right eye 3 years earlier. She reportedly had radiographie evidence of a sphenoid sinus lesion. Biopsy at that time "did not reveal any pathology," and the patient was subsequently lost to follow-up. She presented to our institution with a 6-week history of progressive vision loss in the left eye. She denied epistaxis, nasal airway obstruction, facial pain, headaches, or changes in olfaction. Ophthalmologic evaluation revealed blindness of the right eye and light perception only in the left eye. She also was unable to abduct her right eye. Nasal endoscopy revealed a right sphenoethmoidal recess fullness that lateralized the right superior turbinate. The overlying mucosa was pink and slightly edematous. The rest of the physical examination findings were unremarkable.