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We treated 15 patients (13 males and 2 females) with mucoceles occurring in the posterior paranasal sinuses by surgery. All of the patients complained of varying degrees of visual acuity disturbances, and their ages ranged between 40 and 55 years, with an average of 48.3 years. All had undergone a Caldwell-Luc or Watsuji-Denker operation on the affected side 5 to 30 years (mean: 24.3 years) before the occurrence of the visual disturbances. The mucoceles which had caused the visual disturbances were located in the posterior ethmoid sinus in 6 patients, in the sphenoid sinus in 6 patients, and in both sinuses in the other 3 patients. According to endoscopic observations, bony defects were detected along the optic nerve canal in 12 patients, and dural pulsation due to partial absorption of the anterior skull base bone (minor wing of the sphenoid bone) was seen in 11 patients except for one patient who had suffered an iatrogenic cerebrospinal fluid leak. Severe visual disturbances were noted in 7 patients, two of these patients received an immediate surgical drainage within 24 hours after the onset, and both recovered their visual acuity postoperatively. Another three patients underwent surgery 1 to 7 days after the onset, and the visual acuity improved in only one of these patients. The other two patients had surgical treatment over 8 days after the onset, and only one of them showed minimal improvement in visual acuity. Eight patients who had only slight or mild visual disturbance recovered their original visual acuity and/or remission of blurred vision. However, the surgical drainage was performed relatively late (10 days to 1 year) after the onset of their symptoms. We conclude that visual acuity does not recover when the visual disturbances are severe and the optic disc is atrophic. However, even when the visual disturbances were severe and the optic disc was inflamed, prompt surgical drainage of the mucocele was able to restore the visual acuity. In addition, when the preoperative visual acuity remained measurable, then the postoperative visual acuity could improve, regardless of the findings of the ocular fundus. The early diagnosis of mucoceles in the posterior paranasal sinuses as a cause of visual disturbances and prompt surgical drainage is indispensable.

Mucoceles of the Posterior Paranasal Sinuses and Visual Disturbance.