Intra-optic nerve abscess: A rare complication of acute sinusitis

Abstract

Introduction: Intracranial complications from acute sinusitis are rare. In particular, intra-optic nerve abscess has not been described. A case report and review of orbital complications from sinusitis is presented here to emphasize the extreme rarity of this clinical entity. Methods: Case report and literature review. The patient's pertinent history, clinical findings and radiologic studies are examined. Results: The case of a 33 year old male who was transferred to a tertiary care academic medical center with acute vision loss after developing signs and symptoms consistent with acute sinusitis is presented and reviewed. A computed tomography scan demonstrated pansinusitis with worse severity on the left side. Magnetic resonance imaging revealed a right-sided abscess along the roof of the right sphenoid sinus and the right optic nerve towards the optic chiasm. The patient's clinical exam was consistent with right-sided optic neuropathy. He underwent an emergent functional endoscopic sinus surgery and subsequent right-sided open craniotomy for drainage of an epidural and intracranial abscess involving the right optic nerve, chiasm, and optic tract. The sinusitis was odontogenic in origin. The patient was treated for six weeks with IV ceftriaxone, penicillin and metronidazole and transitioned to five months of PO amoxicillin. At 3-month follow-up, the patient had no evidence of sinusitis and stable ophthalmologic findings. Conclusions: The occurrence of an intra-optic nerve abscess is a rare but possible sequela of acute sinusitis. A multidisciplinary approach involving otolaryngology, neurosurgery, ophthalmology, neuroradiology and infectious diseases is paramount. Surgery and antibiotic therapy is the standard of care.

Keywords

• Optic nerve abscess
• Orbital complication
• Sinusitis
• Odontogenic