BACKGROUND Intracranial extension of a sphenoidal mucocele may be marked by persistent headache, nerve palsies, and total or partial vision loss. METHODS A 74-year-old white male was examined with right frontotemporal headache and constant diplopia. Previously, he had noticed a droop in his right eyelid. RESULTS Careful ophthalmic examination and laboratory studies, including computed tomography revealed a sphenoid mucocele with complications. As a result, the patient underwent a sphenoidectomy. CONCLUSIONS The evaluation of patients with acute onset of multiple eye and vision problems can often lead to a significant neurologic diagnosis.