Long-term therapeutic outcome of ophthalmic complications following endoscopic sinus surgery

Abstract

Ophthalmic complications associated with endoscopic sinus surgery (ESS) are quite rare. There is a paucity of reliable data and limited experience on the clinical findings and treatments of these injuries. Our study here is to characterize the types of orbital injury following ESS, in particular extraocular muscle injury, and to evaluate the long-term therapeutic outcomes as compiled from a relatively large sample of Chinese patients.A series of 27 patients (21 males and 6 females; mean age = 42.6 years, ranges: 10–60 years) were retrospectively reviewed. The mean duration of orbital complication was 6.6 months (ranges: 1 day to 24 months). The right eye was affected in 19 patients and the left in 8 patients. All patients had various extraocular muscle dysfunction, including contusion, oculomotor nerve damage, muscle entrapment, muscle transection, and muscle destruction. All patients subjected to strabismus surgery showed an obvious reduction in deviation. Three patients achieved orthophoria without any surgery during the period of observation. All patients displayed mild to complicated orbital hemorrhage that often disappeared within 2 weeks. Optic nerve injury occurred in 29.6% of patients and vision damage in these patients was often irreversible.All patients with ophthalmic complications after ESS had strabismus and extraocular muscle dysfunction. Timing and type of strabismus surgery performed depended on the severity and number of muscles involved as well as the type of injury. This surgery is less effective in cases of restriction factor adhesion and/or entrapment as compared to that of patients with other types of strabismus. Orbital hemorrhages were usually resolved spontaneously, but optic nerve injury was mostly irreversible.

Isolated Inferior Rectus Muscle Entrapment following Endoscopic Sinus Surgery

“…The lamina is at risk during uncinectomy or ethmoidectomy, with the orbital floor at risk during maxillary antrostomy and sinusotomy [ 11 ], though the orbital floor is generally not considered a high-risk area during sinus surgery [ 6 ]. Although injuries to the inferior rectus muscle have been reported in association with injuries to other orbital structures, most commonly the medial rectus muscle [ 12 ], isolated inferior rectus injuries via orbital floor violation are rare with only one reported case in the literature [ 7 ]. In their reported case, the orbital defect was significantly larger than in our patient, the patient presented earlier (2 weeks versus our 8 months), and with diplopia on both superior and inferior gaze.…”

Managing Complications and Revisions in Sinus Surgery

“…It is therefore advisable to always use cutting instruments in the ethmoid roof. Immediate management with endoscopic medial orbital decompression or lateral canthotomy or a combination is required to prevent optic nerve ischaemia and loss of vision [17].…”

The role of structured reporting and structured operation planning in functional endoscopic sinus surgery

“…Prior to surgery, CT scans are indispensable to determine the extent of FESS as well as to identify anatomical structures with an increased risk regarding catastrophic complications. Such complications may include injuries of the anterior skull base, the orbit, optic nerve or internal carotid artery with potential lethal bleedings, ischemic stroke or need for blood transfusions [5][6][7][8][9]. Especially in the era of powered instruments such as microdebriders, a profound understanding of the anatomy is of utmost importance, as these particular instruments can cause severe complications when handled without sufficient care [10,11].…”