Abdullah M. Assiri, Sultan K. Kadasah, Ali M. Al-Qannass, Saud abdulwahab Aldhabaan, Shahd Saeed Ali Dlboh, Adnan Q. Al-Malki


Introduction: Optic neuropathy refers to damage or impairment of the optic nerve, which can result in vision loss. Onodi cell mucocele is a rare condition that can lead to optic neuropathy and other health-threatening complications. Here we present a case of successfully treated unilateral optic neuropathy secondary to Onodi cell mucocele associated with chronic sinusitis.

Case report: A 45-year-old woman presented with a 4-day history of right eye pain associated with decreased vision and photophobia with chronic nasal obstruction. Physical examination showed pain on downward extraocular muscle movement, vision acuity of 6/60 and 6/9, and right eye Relative Afferent Papillary Defect (RAPD). CT scan findings led to the diagnosis of right optic neuropathy secondary to Onodi air cell mucocele. Emergency endoscopic sinus surgery was successfully performed in the form of anterior and posterior ethmoidectomy and bilateral sphenoidotomy with drainage of Onodi cell mucocele to release pressure on the optic nerve.

Conclusion: Overall, optic neuropathy from Onodi air cell mucocele is a rare but serious complication that requires prompt diagnosis and treatment to prevent permanent vision loss. This case report details the clinical and radiological presentation and management of Onodi cell mucocele and associated optic neuropathy, highlighting the need for healthcare providers to consider it, especially in patients with optic neuropathy and chronic sinusitis.


Onodi cell; Mucocele; Acute optic neuropathy; Optic Nerve Decompression.

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Capra GG, Carbone PN, Mullin DP. Paranasal sinus mucocele. Head Neck Pathol. 2012;6(3):369-372.

Huzaifa M, Soni A. Mucocele And Ranula. In: StatPearls. StatPearls Publishing; 2023. Accessed April 11, 2023.

Nallasivam KU, Sudha BR. Oral mucocele: Review of literature and a case report. J Pharm Bioallied Sci. 2015;7(Suppl 2):S731-733.

Plantier DB, Neto DB, Pinna F de R, Voegels RL. Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients. Int Arch Otorhinolaryngol. 2019;23(1):88-91.

Aggarwal SK, Bhavana K, Keshri A, Kumar R, Srivastava A. Frontal sinus mucocele with orbital complications: Management by varied surgical approaches. Asian J Neurosurg. 2012;7(3):135-140.

Moeller CW, Welch KC. Prevention and Management of Complications in Sphenoidotomy. Otolaryngologic Clinics of North America. 2010;43(4):839-854.

Cherla DV, Tomovic S, Liu JK, Eloy JA. The central Onodi cell: A previously unreported anatomic variation. Allergy Rhinol (Providence). 2013;4(1):e49-51.

Tomovic S, Esmaeili A, Chan NJ, Choudhry OJ, Shukla PA, Liu JK, Eloy JA. High-resolution computed tomography analysis of the prevalence of Onodi cells. Laryngoscope. 2012 Jul;122(7):1470-3. Epub 2012 Jun 8. PMID: 22685058.

Casale M, Costantino A, Sabatino L, Cassano M, Moffa A, Rinaldi V. Image-guided endoscopic marsupialization technique for frontal sinus mucocele with orbital extension: A case report. Int J Surg Case Rep. 2019;61:259-262.

Lee JM, Au M. Onodi cell mucocele: Case report and review of the literature. ENT-Ear, Nose & Throat Journal. Published online 2016.

Fukuda H, Fukumitsu R, Andoh M, Suzuki T, Yamana N, Kataoka H, et al. Small Onodi cell mucocele causing chronic optic neuropathy: case report. Neurol Med Chir (Tokyo) 2010;50(10):953-5. PMID: 21030816.

Yen Nee See W, Sumugam K, Subrayan V. Compressive optic neuropathy due to a large Onodi air cell: A case report and literature review. Allergy Rhinol (Providence). 2016;7(4):223-226.

Tzamalis A, Diafas A, Riga P, Konstantinidis I, Ziakas N. Onodi Cell Mucocele-Associated Optic Neuropathy: A Rare Case Report and Review of the Literature. J Curr Ophthalmol. 2020;32(1):107-113.

Yumoto E, Hyodo M, Kawakita S, Aibara R. Effect of sinus surgery on visual disturbance caused by spheno-ethmoid mucoceles. Am J Rhinol. 1997;11(5):337-343.

Morino T, Yanagihara T, Kuroyanagi H, Ohto H. Optic neuropathy caused by expanded Onodi cell mucocele. BMJ Case Rep. 2020;13(6):e235311.

Kantarci M, Karasen RM, Alper F, Onbas O, Okur A, Karaman A. Remarkable anatomic variations in paranasal sinus region and their clinical importance. European Journal of Radiology. 2004;50(3):296-302.



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