Interpretation of the dilated pupil during endoscopic sinus surgery

Abstract

This article describes the anatomy of the visual pathways and how they should be assessed under anaesthesia. The differential diagnosis of asymmetrical pupils is illustrated with clinical examples and a strategy as to how they should be examined.

Extended applications of endoscopic sinus surgery and its reference to cranial base and pituitary fossa

“…High-dose steroids are the primary treatment of choice in traumatic optic neuropathy [22]. However, if the optic nerve function is deteriorating in spite of these, it would seem reasonable to intervene [23].…”

Danger points, complications and medico-legal aspects in endoscopic sinus surgery

“…This basically depends on the ischemic tolerance of the retina [68], [114], [135], [336], [338], [339], [340], [341], [342], [343]. A pressure-related interruption of the axonal transport in the optic n. can be endured for 8 hours, a total ischemia can be endured for 2–3 hours [341], [343], [344], [345], [346]. …”

“…As a matter of principle, the surgeon should be familiar with examination of an afferent pupillary defect, for instance by means of the pupil comparison test (“swinging flashlight test”) [345], [468], [470]. …”

Pupil size and reaction during functional endoscopic sinus surgery (FESS)1

“…If orbital trauma is suspected during surgery, it is recommended that the pupillary light reflexes are assessed and monitored by the swinging flash light test 8 . This test involves looking for pupillary reactions while shining light in one eye initially, swinging the light rapidly to the other eye and then swinging it rapidly back to the first eye.…”

“…Both of these agents stimulate α1 receptors at the nerve terminal, causing the iris radial muscle to contract and the pupil to dilate (mydriasis). It is known that cocaine if spilled into the eye will cause pupil dilatation, 8 but the effect of cocaine on the pupil when applied intranasally is less well known, especially in conjunction with the general anaesthetic agents. Opiates used in anaesthesia (e.g.…”