Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

Abstract

ObjectiveTo describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS).DesignObservational case report.ResultsThe records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed.ConclusionDespite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies.

A multi-centre, prospective epidemiological surveillance study considering ophthalmic complications of functional endoscopic sinus surgery

“…Other studies have reported significant and long-term loss of visual acuity following ophthalmic complications of FESS, but this is fortunately rare. 6–8 The current study showed that, in the UK, vision loss secondary to ophthalmic complications of FESS is similarly rare.…”

“…All of these patients had good visual acuity (0.2 logmar or better). Other studies have shown that significant and longterm loss of visual acuity following OCESS has been reported but it is fortunately rare (6,7,8) .…”

Orbital Complications Associated with the Treatment of Chronic Rhinosinusitis

“…3 Blindness may result from a retrobulbar venous hematoma in 60 to 90 minutes, and arterial bleeding may occur in less than 30 minutes. 3,[12][13][14] This situation can be recognized intraoperatively by noting sudden proptosis and hardening of the eye. The eye should be untaped, and the pupillary Fig.…”

“…3,12 All nasal packing should be removed, the head of the bed should be elevated, and administration of mannitol (2 g/kg of a 15%-25% solution over 30 minutes) and 10 mg of dexamethasone should be considered while awaiting IOP evaluation; 1 to 2 drops of timolol ocular drops may be administered. 3,[12][13][14] If immediate measurement of the IOP or ophthalmology evaluation is not possible, and there is evidence of a hardening proptotic globe with APD, the surgeon should not hesitate to perform an immediate lateral canthotomy and cantholysis, 14 which is an essential, vision-preserving maneuver. With immediate lateral canthotomy, the IOP can decrease by up to 15 mm Hg.…”

<p>Central Retinal Artery Occlusion After Nasosinal Surgery – an Insight</p>

“…2 Although there have been a few case reports discussing CRAO after ear, nose, throat (ENT) procedures, the occurrence is even rarer and several mechanisms have been proposed for such an event to occur. 3,4 Documentation and a thorough ophthalmic evaluation at the initial presentation is critical in determining pathophysiology of the event. Several authors have emphasized a critical time window during which emergent management may salvage useful vision in the eye.…”