Nasopharyngeal carcinoma presenting with rapidly progressive severe binocular optic neuropathy and periocular pain in a young man.

A 27-year-old man presented with rapid and severe visual loss in both eyes, together with pain behind the eyes. Visual acuities were light perception in both eyes. Pupillary constriction to light was minimal, and ophthalmoscopy results were normal. For a presumptive diagnosis of retrobulbar optic neuritis, he was treated with intravenous corticosteroids, and vision improved transiently. But vision later worsened to no light perception, and MRI revealed bilateral optic nerve enhancement with dural enhancement and thickening in the anterior skull base, sella, and retroclival areas, findings initially interpreted as inflammatory. Nasopharyngoscopy disclosed a soft tissue lesion filling the apex of the nasopharynx and the posterior portion of the ethmoid sinus with associated sinusitis. Biopsy demonstrated a moderately differentiated squamous cell carcinoma believed to have originated in the nasopharynx. This is the first case of bilateral severe optic neuropathy in nasopharyngeal carcinoma invading the skull base. It is reported to emphasize that rapidly progressive severe bilateral optic neuropathy in a young patient with periocular pain need not be caused by inflammation.