Vision loss associated with orbital surgery – a major review

Principles of Protection of the Eye and Vision in Orbital Surgery

“…4 In 2019, Kansakar and Sundar reported specifically on the incidence of blindness after orbital tumor excisions (4.7%), posttraumatic orbital reconstruction (2.08%), and orbital decompressions for thyroid orbitopathy (0.15%). 5 Mechanisms of injury leading to vision loss in orbital surgery include direct ocular and optic nerve injury, optic nerve compression, and optic nerve ischemia. Direct optic nerve injury can occur intraoperatively from mechanical, thermal, and electrical sources.…”

“…Direct optic nerve injury can occur intraoperatively from mechanical, thermal, and electrical sources. 5 Additionally, the globes themselves may be penetrated by instrumentation or even inadvertently enucleated during functional endoscopic sinus surgery. 6 Optic nerve compression can occur secondary to retrobulbar hemorrhage, particularly in patients who are on anticoagulants, or in the setting of prolonged and aggressive retraction, malpositioned implants, or other malpositioned surgical materials.…”

“…For instance, removal of larger lesions results in a smaller working space making traumatic dissection, greater distortion of tissue, and aggressive prolonged retraction more likely. 5 Lesions in contact with the optic nerve or invading the optic canal and orbital apex lesions in the superomedial vascular quadrant also carry a higher risk of removal. 5 The nature of the lesion also affects prognosis: vascular, poorly encapsulated, cystic, and infiltrative lesions carry a higher risk, as do recurrent tumors.…”

“…5 Lesions in contact with the optic nerve or invading the optic canal and orbital apex lesions in the superomedial vascular quadrant also carry a higher risk of removal. 5 The nature of the lesion also affects prognosis: vascular, poorly encapsulated, cystic, and infiltrative lesions carry a higher risk, as do recurrent tumors. 5 In general, age and preoperative visual status correlate with the risk of vision loss.…”

“…5 The nature of the lesion also affects prognosis: vascular, poorly encapsulated, cystic, and infiltrative lesions carry a higher risk, as do recurrent tumors. 5 In general, age and preoperative visual status correlate with the risk of vision loss. Younger patients are better able to compensate for deprivation of blood flow, and a longer preoperative duration of vision loss is more likely to result in a poor postoperative visual outcome.…”