PMC2823030_01
Visual field defect (dark area) was noted in the whole area, except in the small inferomedial portion of the field, on the day of surgery (A). The visual field defect (dark area) improved but an extensive visual field defect remained, except in the inferomedial portion of the field 8 days after sinus surgery (B) in Case 1.
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F1
Visual field tests showed deficits in all areas except in the inferior-lateral portion (Fig. 1), and intact light reflexes. Ten days after the completion of this symptomatic treatment, a visual field examination revealed a slight visual field improvement (Fig. 1), but no change in visual acuity.
Axial MRI showing a defect of the superolateral wall of the right sphenoid sinus with an exposed optic nerve (A, white arrow). Coronal MRI showing high signal intensity above the internal carotid artery (B, white arrow), possibly due to an intraparenchymal hemorrhage in Case 1.
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F2
However, an orbital MRI showed a defect of the superolateral wall of the right sphenoid sinus with an exposed optic nerve (Fig. 2).
PMC2823030_02
Visual evoked potential test findings 8 days after sinus surgery. A flat wave for the left eye indicated complete loss of visual activity in Case 2.
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F3
On the second day of admission (8 days after surgery), a visual evoked potential (VEP) test revealed an absence of left optic nerve activity (P100: not detected, flat wave) (Fig. 3).
The loss of the fat line around the medial rectus muscle and enhanced signal intensity around the medial rectus and posterior to the optic nerve (white arrow) in T1 and T2-weighted MRIs in Case 2.
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F4
Contrast enhancement around the left medial rectus muscle and behind the left optic nerve was also observed (Fig. 4).
PMC2823030_03
Axial CT showing a small right medial wall fracture and a possible partial defect in the right optic nerve. A thick bony septa was seen in the ethmoid area (white arrow) in Case 3.
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F5
The orbital CT from the local radiology center showed a small right medial wall fracture. (Fig. 5) A thick bony septa observed in the right ethmoid area. (Fig. 5) On the first day of admission in our hospital (2 days after surgery), steroid therapy was started for traumatic optic neuropathy.
Orbital MRI showing a mild enhancement of the posterior half of the right optic nerve sheath (white arrow) and a dark signal focus of medial rectus muscle near the right orbit apex in Case 3.
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F6
Orbital MRI was performed on the second day of admission and showed a mild enhancement of the posterior half of the right optic nerve sheath, and a dark signal focus of medial rectus muscle near the right orbit apex (Fig. 6).