What question did this study set out to answer?

To examine the anatomy of the optic strut and its role in vision loss due to mucocele.

January 17, 2026International Journal of Surgery0 citationsOpen Access

The optic strut: an easily overlooked structure that might cause vision loss

ZCZirong ChenCentral South University HZHua ZhangCentral South University ZXZhihai XieCentral South University

Key Points

To examine the anatomy of the optic strut and its role in vision loss due to mucocele.
Analyzed 5 cases of optic strut mucocele from 2013 to 2023.
Conducted a literature review on nasal mucoceles and orbital apex anatomy.
Summarized anatomical characteristics and their impact on symptoms based on reported cases.
Performed descriptive statistical analysis on relevant data from literature.
One patient had no significant vision improvement; four experienced recovery with varying degrees (0.5→1.2 to 1.0→1.2).
All 19 detailed cases from the literature demonstrated vision loss (100%) alongside symptoms like headache and afferent pupillary defect.
Lesions primarily involved the anterior clinoid process and sphenoid sinus, showing characteristic imaging features.
Endoscopic endonasal surgery was performed in 63.2% of cases, with timely intervention leading to visual recovery in 52.6% of patients.

Abstract

Objective: To discuss the anatomy of the optic strut (OS) and its implications for the diagnosis and treatment of vision loss caused by OS mucocele. Methods: We collected and analyzed 5 cases of OS mucocele with vision loss treated from 2013 to 2023, and reviewed literatures on nasal mucoceles and orbital apex anatomy. By comparing reported cases, we summarized the OS anatomical characteristics and their effects on patient symptoms. Concurrently, a comprehensive narrative literature review was conducted using PubMed, Embase, and Web of Science databases to identify studies on optic neuropathy caused by mucoceles in the OS and adjacent structures (anterior clinoid process, sphenoid sinus, ethmoid sinus). Relevant data were extracted for descriptive statistical analysis. Results: All patients were followed up for 6 months postoperatively. One patient showed no significant vision improvement, while the other four had vision recovery: 0.5→1.2, 0.6→1.0, 0.7→1.0, and 1.0→1.2 (typical case). For the narrative literature review, 15 studies encompassing 48 cases were included, with 19 cases analyzed in detail. All 19 cases presented with vision loss (100%), accompanied by headache (68.4%) and afferent pupillary defect (APD, 47.4%) in partial cases. Lesions were confined to the anterior clinoid process in 4 cases and involved the sphenoid sinus in the rest, showing expansile features on CT and high T2 signal on MRI. Endoscopic endonasal surgery was adopted in 63.2% of cases; timely intervention achieved complete visual recovery in 52.6% of patients, whereas delayed treatment frequently led to optic atrophy. Conclusions: The OS is a bony structure separating the superior orbital fissure, optic canal, and internal carotid artery. OS mucocele–induced pressure elevation and inflammation can damage the optic nerve and cause vision loss. Prompt surgical resection and optic nerve decompression are critical for preserving visual function in patients with space-occupying lesions around the optic canal.

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