Cholesteatoma of the sphenoid sinus presenting as painful optic neuropathy

The authors examined a 45-year-old-woman complaining of a dull pain located in the left retro-orbital area, which had started six months previously. She also reported a progressive blurring of vision in the left eye that had developed over the last two months. She had a history of chronic sinusitis beginning in her twenties. Two years prior to the examinaton she had sustained a minor head injury. Skull X-rays performed at that time showed a mass lesion in the sphenoid sinus, which however was overlooked. The authors found that visual acuity was 20/20 in both eyes and that, with Goldmann kinetic perimetry, the blind spot was enlarged and isopters were moderately constricted in the left eye. CT scan and MRI showed a large homogeneous non-enhancing lesion within the left sphenoid sinus, compressing the left optic nerve. At surgery, an encapsulated cyst was found containing a yellowish material. Histological examination led to a diagnosis of cholesteatoma. To the authors′ knowledge, this is the first descript...