Ophthalmic complications of endoscopic ethmoid surgery and their management

Abstract

Purpose: The proximity of the paranasal sinuses to the orbit puts the anterior visual pathways at risk during sinus surgery. Although the ophthalmic complications of sinus surgery are well known to the otolaryngologist, they are rarely encountered in clinical practice. Several recommendations will help the surgeon performing intranasal sinus surgery. Materials and Methods: To study the incidence of orbital complications of intranasal ethmoid surgery, a retrospective review of 372 cases, most of them bilateral, was performed. Results: Our series of 372 patients who underwent endoscopic sinus surgery showed five orbital complications. Conclusion: Several recommendations may help the surgeon to avoide any ophthalmic complication. When orbital wall dehiscence is suspected, either by CT scan or at surgery, especially in a previously operated case, extreme care should be taken not to penetrate the periorbita. If orbital fat protrudes into the operative field, it should not be pulled or twisted in an attempt to remove it. The surgeon should seek the cooperation of the anesthesiologist working the case. A knowledge of the variable anatomy is essential to avoid iatrogenic injury. The surgeon should be aware of the different complications for early recognition and management.