Optic Neuropathy

Paranasal sinus disease can cause a condition that mimics optic neuritis. Simultaneous appearance of both diseases
would create etiological dilemma. We report two cases of retrobulbar optic neuropathy secondary to isolated sphenoid
sinus disease. In the case of a 65‑year‑old female who had presented with acute loss of vision in the left eye associated
with left‑sided frontal headache which subsequently turned out to be caused by optic nerve compression at the orbital
apex due to collection in abnormally pneumatized left lesser wing of the sphenoid. In another case, a 65‑year‑old
lady had presented with symptoms of bilateral retrobulbar optic neuropathy which was found to be due to direct
compression of optic nerves at the orbital apex secondary to metastases from breast carcinoma.

A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. He has a history of fever of unknown origin. Examination revealed bilateral optic disc granulomas with mild vitritis. Serum angiotensin converting enzyme was found to be elevated and tuberculin skin test was negative. Computed tomography scan of the chest showed clear lung fields with no hilar lymphadenopathy but mildly enlarged pretracheal lymph nodes. Computed tomography scan of the abdomen revealed multiple enlarged abdominal lymph nodes with hepatosplenomegaly, and ultrasound-guided biopsy of one of these lymph nodes showed chronic granulomatous inflammation consistent with sarcoidosis. Immunosuppressive therapy resulted in resolution of ocular inflammation with no recurrence.

Background: Methanol is a highly toxic alcohol and causes such severe side effects as CNS depression, blindness, acute renal failure and even death. Methods: Patients were three male referrals (aged 29-56 years) to the poisoning center at Taleghani Hospital, Urmia, Iran, in 2020. They had unknowingly ingested methanol. Their chief problems were bilateral blindness and metabolic acidosis. Upon taking medical history and physical examinations, they were assessed by an ophthalmologist, while testing the arterial blood gases and standard laboratory tests. They were given standard treatments and antidotes 3-4 days, which did not reverse the blindness. Subsequently, each patient was injected with five doses of subcutaneous erythropoietin every second day. The visual acuity progress was monitored daily until their discharge from the hospital. Results: Following 3-4 days of ineffective standard treatments, patients were injected with low doses of subcutaneous erythropoietin, which gradually reversed the visual acuity to normal level over the next 7 to 9 days. The patients were discharged from the hospital 10-12 days post admission, with normal visual acuity and without having any side effects. Conclusion: The subcutaneous erythropoietin effectively relieved the acute optic neuropathy and reversed the blindness to normal vision. This study is the first to investigate the therapeutic effects of subcutaneous erythropoietin in the treatment of optic neuropathy secondary to methanol intoxication.