Neuro-Ophthalmic Manifestations of Skull Base Mucocele with MSSA Infection

Paranasal sinus mucoceles can present with various ophthalmic symptoms because of their capacity to expand and impinge on nearby nerves and vasculature. We present a 64-year-old white female with blurry vision OD, binocular oblique diplopia, headaches, and pupillary trace escape OD that started in 2023. The patient has a significant past medical history for multiple sinus diseases and surgeries and chronic immunosuppression. Despite several visits with ophthalmology, optometry, and neurosurgery, no definitive diagnosis was made due to the variability in imaging and clinical features. Finally, a right total ethmoidectomy, right sphenoidotomy, bilateral inferior turbinate lateralization, and image guided endoscopic sinus surgery biopsy were conducted, revealing a skull base mucocele and an MSSA infection.