Iatrogenic Injury to Medial Rectus After Endoscopic Sinus Surgery

Abstract

Endoscopic sinus surgery (ESS) is the mainstay of the treatment in sinus disorders, to re-establish the drainage of the affected sinus. The close proximity of the orbital structures to paranasal sinuses makes them vulnerable to inadvertent injury during the sinus surgery. Medial rectus (MR) muscle is the most commonly injured extraocular muscle during ESS due to its anatomic proximity to the thin medial wall of the orbit. This is a non-comparative, retrospective, interventional case series of six patients presenting with MR injury after ESS. We discuss the management, outcome and review the published literature. A total of six patients met the inclusion criteria. The presenting complaints were diplopia, squinting and limitation of ocular movements. Two patients underwent surgical exploration of the MR muscle and reattachment of the muscle along with injection botulinum to the antagonist lateral rectus muscle. Two patients who had small angle strabismus and who were able to fuse were advised orthoptic exercises and prisms as management. Remaining two patients were advised surgical intervention to correct strabismus but they declined further surgical intervention. Management of MR injury following ESS is complex, often resulting in suboptimal outcomes. Since early intervention is associated with better outcomes, early referral by otolaryngologists to ophthalmologists would result in better outcome.

Medial Rectus Muscle Injuries After Functional Endoscopic Sinus Surgery: A Case Study

“…Ophthalmic complications may be categorized as follows: minor (grade I) injuries involve damage to the lamina papyracea, major (grade II) injuries involve the lacrimal duct, and serious (grade III) complications encompass retroorbital hemorrhage, optic nerve injury leading to vision reduction or blindness, and extraocular muscle damage [ 1 , 2 ]. The medial rectus (MR) muscle is the extraocular muscle most frequently injured during FESS because of its proximity to the thin medial orbital wall [ 3 ].…”

Medial Rectus Anastomosis Under Endoscopic Endonasal Orbital Approach With Image-Guided Navigation: A New Way of Repairing a Ruptured Medial Rectus

“…Recently, many cases about injuries of the medial rectus during ESS are reported. [3][4][5][6] Stankiewicz et al reviewed the complications in ESS for chronic rhinosinusitis involving 3402 patients (6148 sides) during a period of 25 years. An overall patient complication rate of 3.1%, or 1.7% per operated side, was noted.…”