Irreversible Bilateral Blindness from Compressive Optic Neuropathy Caused by a Left Sphenoid Wing Meningioma Despite Radiological Response to Radiotherapy: A Case Report

Abstract

Aims: To highlight the risk of irreversible blindness from delayed recognition of compressive optic neuropathy caused by a sphenoid wing meningioma and to emphasise that radiological tumour control does not necessarily imply visual recovery once optic atrophy is established. Presentation of Case: An octogenarian woman presented with painless progressive bilateral visual loss over 6 months. Visual acuity was reduced to light perception; the anterior segments were quiet, and fundus examination showed bilateral optic atrophy. Brain magnetic resonance imaging revealed a 27 × 18 mm intensely enhancing left spheno-temporofrontal extra-axial mass compatible with a sphenoid wing meningioma. The lesion encased the left middle cerebral and intracavernous internal carotid arteries while preserving their patency and extended to the lateral aspect of the optic chiasm. Radiotherapy was subsequently administered. Follow-up imaging showed tumour regression, but vision did not recover, and the patient ultimately developed bilateral blindness attributed to irreversible compressive optic neuropathy. Discussion: Chronic optic nerve or chiasmal compression may progress from potentially reversible dysfunction to permanent axonal loss and optic atrophy. Radiotherapy can achieve tumour control in selected meningiomas affecting the visual pathways, but established optic atrophy markedly limits functional recovery. Conclusion: Progressive visual loss associated with optic disc pallor requires urgent neuroimaging. Early diagnosis and treatment of compressive optic neuropathy are essential because delayed management may result in permanent blindness despite subsequent radiological tumour control.