Optic neuropathy and diplopia caused by Onodi cell infections

We report on Onodi cell infections that led to visual loss in one case and diplopia in the other. In the patient exhibiting visual loss due to an Onodi cell lesion, quick recovery was noted immediately after the sinus surgery for the Onodi cell. In the diplopia case, the patient was found to have ethmoid mucocele, frontal sinusitis and Onodi cell infection. Although the diplopia did not change after the operation for the ethmoid and frontal sinuses, it did disappear after the subsequent Onodi cell surgery. Infection of the Onodi cell is likely to be underestimated due to the complex anatomy and the large operative risk for its size. Even though it is only very small, the Onodi cell needs to be considered as a pathogen not only in patients with visual loss but also those with diplopia.