Potentially life threatening complication of conjunctivodacryocystorhinostomy

Abstract

Most of these cases were associated with subretinal leakage and posterior staphyloma, which were not present in our case. 5À7 Two other cases of adult patients with serous macular detachment associated with DSM and tilted discs have been described. Both of these patients had posterior staphyloma and subretinal leakage, which were not present in our case. 11 Our hypothesis for this case is that the dome-shaped curvature of the macula might have contributed to the development of foveal subretinal fluid as suggested in the study that described this entity. 9 Dysfunction of the RPE might have played a role in the accumulation of the subretinal fluid as described for DSM 9 and the tilted disc syndrome. 6 Some authors suggested that the sclera thickening associated with DSM could cause an obstruction of the outflow of choroidal fluid. 12 No evidence of vitreous traction was found. Nonetheless, the exact mechanism of accumulation and spontaneous resorption of foveal subretinal fluid remains unknown in the medical literature for these entities.OCT scans remain very useful in the detection of a DSM and the macular complications associated with a tilted optic disc. However, more studies need to be done on pediatric patients to understand these entities and to clarify the causes and the treatments of their complications.

Facial Swelling After External Dacryocystorhinostomy

“…Subcutaneous emphysema is a rare but known complication associated with dacryocystorhinostomy . The connection that is made between the nasal mucosa and the lacrimal sac creates a susceptibility for forced air to become trapped within the subcutaneous tissues.…”

“…The spread of air can involve the orbits, which can raise the intraorbital pressure and pose immediate risk to the optic nerve, which requires emergency decompression when present . In extreme scenarios, subcutaneous emphysema can extend to the chest wall, posing risk for airway compromise and tension pneumomediastinum . Lastly, subcutaneous emphysema can mimic necrotizing fasciitis .…”

“…Subcutaneous emphysema is a rare but known complication associated with dacryocystorhinostomy. [1][2][3] The connection that is made between the nasal mucosa and the lacrimal sac creates a susceptibility for forced air to become trapped within the subcutaneous tissues. This likely occurs due to disruption in the mucosal barrier following the procedure, which can act as a one-way valve to trap air.…”

“…7 In extreme scenarios, subcutaneous emphysema can extend to the chest wall, posing risk for airway compromise and tension pneumomediastinum. 2 Lastly, subcutaneous emphysema can mimic necrotizing fasciitis. 1 Surgical procedures introduce the risk for postoperative infection, with rates of cellulitis after external dacryocystorhinostomy estimated to be between 1.2% and 7.9% based on whether systemic antibiotic prophylaxis is used or not.…”