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Complete orbital apex syndrome from an onodi cell mucocele: a case report.

Connor Nathe, Elizabeth Shen, Robert W. Crow

Mucoceles of the posterior ethmoid sinuses are rare, mucous-filled cyst-like lesions that may cause orbital apex syndrome. We present a rare case of complete unilateral orbital apex syndrome in an 86- year old woman secondary to an Onodi cell mucocele. She presented with vision loss of the right eye to no light perception as well as complete ophthalmoplegia in that eye. She had significant improvement in vision and complete resolution of ophthalmoplegia following urgent endoscopic surgical decompression. Despite her improvement in vision, mild thinning of the optic nerve was demonstrated on optical coherence imaging of the nerve fiber layer over the next several months, indicating limited yet irreversible damage to the optic nerve. This highlights the need for increased clinical suspicion for orbital apex syndrome due to Onodi cell mucocele and a readiness for prompt surgical intervention.