PMC3350013_01
Fundal examination reveals a pale left optic nerve.
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fig1
Right fundal examination was unremarkable whilst the left fundus exam revealed pallor of the left optic disc (Figure 1).
MRI scan shows an abnormal soft tissue lesion within the left paranasal sinuses centered on the ethmoid air cells. Note the distortion of the medial wall of the orbit and narrowing of the orbital apex causing distortion and compression of the left optic nerve.
CRIM.OPHMED2012-894062.002.jpg
PMC3350013_01_CRIM.OPHMED2012-894062.002.jpg
fig2
At this stage a progressive optic neuropathy was suspected and an urgent MRI scan organised which revealed a large soft tissue lesion within the left paranasal sinuses centred on the ethmoidal air cells with narrowing of the medial wall of the orbit causing optic nerve distortion and compression (Figure 2).