Bilateral visual loss and ipsilateral ophthalmoplegia due to unilateral sphenoid sinus mucocele

Bilateral impaired visual acuity, unilateral oculomotor and trochlear nerve paresis, and headache due to sphenoid sinus mucocele is rare. An 81-year-o ld woman developed bilateral headache, left-sided ptosis, bilateral visual impairment, diplopia, and rhinorrhea. Neurologic examination revealed bilat erally reduced visual acuity and left-sided paresis of the oculomotor and t rochlear nerves. Spiral CT and T2-weighted MRI of the perinasal sinuses rev ealed a left-sided sphenoid sinus mucocele with bony destruction of the sur rounding walls and involvement of the orbital apex. Endonasal transsphenoid al drainage of the mucocele led to a complete recovery of the cranial nerve palsies and marked improvement of visual acuity. Sphenoid sinus mucocele c an present with bilateral visual loss and unilateral oculomotor and trochle ar nerve paresis. Endoscopic drainage of the mucocele can lead to almost co mplete recovery.