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Silent threat of isolated sphenoid sinus tuberculosis resulting in blindness and ophthalmoplegia
  1. Goutham Maniyankode Krishnamohan1,
  2. Anshuli Rajeeva2 and
  3. Lobo Manuel Alexander3
  1. 1Otorhinolaryngology, KS Hegde Medical Academy, Derelakette, Karnataka, India
  2. 2Otorhinolaryngology, NITTE KS Hegde Medical Academy, Mangalore, Karnataka, India
  3. 3Neurology, KS Hegde Medical Academy, Mangalore, Karnataka, India
  1. Correspondence to Dr Anshuli Rajeeva; anshraj.130{at}


A diabetic woman in her fifties presented with a sudden onset of failing vision and diplopia involving the right eye for two days, along with fever and headache. Radiological investigations revealed right sphenoid sinusitis along with inflammation around the right orbital apex and optic nerve. Functional endoscopic sinus surgery, with orbital and optic nerve decompression improved the ocular movements, but not the visual acuity. Histopathology was suggestive of a granulomatous inflammatory lesion, and high-resolution computed tommography (HRCT) of the thorax revealed lung lesions suggestive of an old tubercular infection, and antitubercular treatment (ATT) was then initiated.

At the end of two months of ATT, there was complete resolution of ophthalmoplegia, relative afferent pupillary defect, direct and consensual light reflex however, failure of improvement in her visual acuity, indicated damage to the optic nerve.

Extrapulmonary tuberculosis involving an isolated sphenoid sinus is rare and elusive. Prompt radiological investigations, followed by orbital decompression and ATT, provide the best possible outcomes.

  • Ear, nose and throat/otolaryngology
  • TB and other respiratory infections
  • Visual pathway
  • Otolaryngology / ENT

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  • Contributors GMK, AR were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content. LMA gave final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.