Ophthalmic Complications after Surgery for Nasal and Sinus Polyposis

Purpose To describe ophthalmic complications after nasal and sinus surgery. Methods Four cases with orbital complications were retrospectively selected from among more than 2000 cases of orbital pathologies. Results Motility disturbances due to extraocular muscle injury occurred in two patients after intranasal ethmoidectomy and in one patient after a Caldwell-Luc procedure. In the fourth case an orbital apex syndrome was noted after intranasal ethmoidectomies. Conclusions Ophthalmic complications may occur after nasal and sinus surgery, even using an endoscopic procedure. Successful handling of these complications could be reached by on their early recognition and treatment.

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Granulomatosis with Polyangiitis Presenting with Bilateral Orbital Apex Syndrome

Case Reports in Ophthalmology ◽

10.1159/000510329 ◽

2021 ◽

pp. 32-40

Author(s):

Yusuke Murai ◽

Takuji Kurimoto ◽

Sotaro Mori ◽

Kaori Ueda ◽

Mari Sakamoto ◽

...

Keyword(s):

Visual Field ◽

Eye Movement ◽

Endoscopic Sinus Surgery ◽

Granulomatosis With Polyangiitis ◽

Field Tests ◽

Sinus Surgery ◽

Orbital Apex ◽

Orbital Apex Syndrome ◽

Initial Examination ◽

Steroid Pulse

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with bilateral orbital apex syndrome (OAS). A 73-year-old woman with a history of endoscopic sinus surgery for ethmoidal sinusitis experienced a sudden decrease in visual acuity (VA) of both eyes. At the initial examination, her VA had decreased to 0.01 in the right eye and 0.03 in the left eye, and eye movement in both eyes was mildly limited in all directions. Visual field tests of both eyes showed a large central scotoma. Laboratory tests revealed an elevation of myeloperoxidase-anti-neutrophil cytoplasmic antibody. Facial computed tomography demonstrated a thickened mucosal membrane in the entire ethmoidal sinus, and the posterosuperior walls of Onodi cells filled with infiltrative lesions had thinned. Orbital magnetic resonance imaging showed severe inflammation in the orbital apex. From these clinical findings, the patient was diagnosed with GPA presenting with OAS associated with ethmoid sinusitis. Emergent endoscopic sinus surgery was performed for biopsy and debridement of the ethmoidal and sphenoid sinusitis to decompress the optic nerve. One day after endoscopic sinus surgery, the patient’s VA and visual field were improved, and steroid pulse therapy was commenced postoperatively. Four days later, VA had recovered to 1.0 in both eyes, and eye movement and visual field had were improved. Although OAS is a rare manifestation, early surgical treatment should be considered when the orbital lesion presents as risk of rapid deterioration of visual function in patients with GPA.

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Extraocular muscle injury during endoscopic sinus surgery: an ophthalmologic perspective

Eye ◽

10.1038/eye.2016.15 ◽

2016 ◽

Vol 30 (5) ◽

pp. 680-687 ◽

Cited By ~ 3

Author(s):

K-A Park ◽

S Y Oh

Keyword(s):

Endoscopic Sinus Surgery ◽

Extraocular Muscle ◽

Muscle Injury ◽

Sinus Surgery

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Extraocular muscle injury during endoscopic sinus surgery: A series of 10 cases at a single center

Rhinology Journal ◽

10.4193/rhin13.131 ◽

2014 ◽

Vol 52 (3) ◽

pp. 238-245 ◽

Cited By ~ 3

Author(s):

J.H. Sohn ◽

S.D. Hong ◽

J.H. Kim ◽

H.J. Dhong ◽

S.K. Chung ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Extraocular Muscle ◽

Muscle Injury ◽

Sinus Surgery ◽

Single Center

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Extraocular Muscle Damage Associated with Endoscopic Sinus Surgery: An Ophthalmology Perspective

American Journal of Rhinology ◽

10.1177/194589240501900414 ◽

2005 ◽

Vol 19 (4) ◽

pp. 400-405 ◽

Cited By ~ 30

Author(s):

Neepa M. Thacker ◽

Federico G. Velez ◽

Joseph L. Demer ◽

Marilene B. Wang ◽

Arthur L. Rosenbaum

Keyword(s):

Muscle Damage ◽

Endoscopic Sinus Surgery ◽

Surgical Procedure ◽

Extraocular Muscle ◽

Muscle Injury ◽

Rectus Muscle ◽

Sinus Surgery ◽

Medial Rectus ◽

Orbital Wall ◽

Operative Notes

Background Orbital complications associated with endoscopic sinus surgery are well documented. Damage to the medial rectus muscle results in complicated strabismus and disturbing diplopia. The aim of this study was to characterize the types of extraocular muscle injury and the number of muscles involved that may complicate endoscopic sinus surgery and correlate its occurrence to factors in the surgical procedure itself. Methods A retrospective chart review was performed of 14 patients with strabismus after endoscopic sinus surgery. Operative notes of the surgical procedure, pathology reports of the intraoperative specimens, postoperative pattern of strabismus, the extraocular muscle involved, and the type of muscle injury characterized by orbital imaging were reviewed in each patient. Results In our series, not only the medial rectus muscle but also the inferior rectus and the superior oblique muscles were damaged with multiple muscles being involved in one patient. Extraocular muscle injury varied from hematoma, entrapment of muscle in the fractured orbital wall, damage to the oculomotor nerve entry zone, muscle transection, and partial or complete muscle destruction with entrapment in scar tissue. Use of the microdebrider causes extensive irreparable muscle damage. Conclusion Extraocular muscle damage complicating endoscopic sinus surgery can produce therapeutically challenging complicated strabismus.

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Medial Rectus Anastomosis Under Endoscopic Endonasal Orbital Approach With Image-Guided Navigation: A New Way of Repairing a Ruptured Medial Rectus

Ear Nose & Throat Journal ◽

10.1177/0145561319869608 ◽

2019 ◽

pp. 014556131986960

Author(s):

Ying-Xing Wu ◽

Zhi-Yong Li ◽

Ban Luo ◽

Xiao-Bo Long ◽

Nan Xiang ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Muscle Injury ◽

Professional Training ◽

Rectus Muscle ◽

Sinus Surgery ◽

Medial Rectus ◽

Endoscopic Endonasal ◽

Image Guided ◽

Correct Application ◽

Orbital Complications

Background: With the extensive development of endoscopic sinus surgery, iatrogenic medial rectus muscle injury should be treated with caution. Traditional methods to repair a ruptured medial rectus need an anterior orbitotomy approach, with more injury and difficulty in finding the posterior end of the ruptured medial rectus. Objective: To explore a new method to repair a ruptured medial rectus. Methods: Eight cases of iatrogenic medial rectus rupture after endoscopic sinus surgery were reviewed from July 2015 to January 2019. Assisted by image-guided navigation, the ruptured medial rectus was sutured under an endoscopic endonasal orbital approach. Two methods were designed to suture the ruptured medial rectus. Optic nerve and orbital decompression were performed in 5 cases with visual impairment. The extent of exotropia and diplopia were followed up for 5 to 33 months after surgery. Results: With the help of image guidance, the posterior and anterior ends of the ruptured medial rectus of all patients were pinpointed, and operations using medial rectus anastomosis were successfully completed in 7 patients. The exotropia of these patients was corrected, and they have recovered. The vision of 2 patients recovered. There were no minor or major complications intraoperatively or postoperatively. Conclusion: Assisted by image-guided navigation, medial rectus anastomosis under an endoscopic endonasal orbital approach is a feasible method. The key to preventing orbital complications is strict professional training, including identification of the Onodi air cell and correct application of powered instrumentation.

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Extraocular muscle injury during endoscopic sinus surgery: a series of 10 cases at a single center

Rhinology Journal ◽

10.4193/rhino13.131 ◽

2014 ◽

Vol 52 (3) ◽

pp. 238-245

Author(s):

J.H. Sohn ◽

S.D. Hong ◽

J.H. Kim ◽

H.-J. Dhong ◽

S.-K. Chung ◽

...

Keyword(s):

Endoscopic Sinus Surgery ◽

Extraocular Muscle ◽

Muscle Injury ◽

Case Series ◽

Rectus Muscle ◽

Strabismus Surgery ◽

Sinus Surgery ◽

Medial Rectus ◽

Inferior Rectus ◽

Retrospective Case

Background: Extraocular muscle (EOM) injury is a rare but serious complication of endoscopic sinus surgery (ESS). The aim of this study is to describe the clinical characteristics and course of EOM injury occurring during ESS. Design: Retrospective case series. Methods: Medical records and CT images of patients who suffered from EOM injury after ESS between 2006 and 2012 were retrospectively reviewed. Patient demographics, endoscopic anatomy, type of surgery (primary or revision), predisposing risk factors, site and extent of injury on CT imaging, and associated complications were evaluated. In addition, data regarding ophthalmologic management and clinical outcomes were collected. Results: Ten patients with EOM injuries after ESS were included in this study. One patient was undergoing revision ESS. All patients sustained medial rectus muscle injury and one patient suffered concurrent ipsilateral inferior rectus muscle injury. A microdebrider was used in nine cases. Right-sided injury (90% of patients) was more prevalent than left-sided injury, and 70% of injured medial rectus muscles were completely transected. After subsequent strabismus surgery, 8/9 patients regained binocular single vision in primary gaze despite residual diplopia in some gaze positions. Conclusion: Although proper ophthalmologic surgery after EOM injury may improve deviation in the primary gaze position, none of the patients regained normal EOM movement. Therefore, prevention of this complication through adequate surgical technique and precautions is important.

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