scholarly journals Delayed Sudden Blindness From Unilateral Ophthalmic Artery Vasospasm Following Endoscopic Sinus Surgery?

2021 ◽  
Vol 36 (1) ◽  
pp. 62
Author(s):  
Ruben Chua Jr ◽  
Joyce Anne Regalado ◽  
January Gelera
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Ophthalmic Artery ◽  
Sinus Surgery ◽  
Retinal Hemorrhages ◽  
Eye Pain ◽  
Lateral Canthotomy ◽  
Periorbital Swelling

Keywords: ophthalmic artery; vasospasm; iatrogenic; endoscopic sinus surgery; blindness   Endoscopic sinus surgery (ESS) is a generally benign, minimally invasive procedure used for management of paranasal sinus diseases, although complications may occur due to proximity of vital structures such as the brain, orbit and great vessels.1 The overall ESS major complication rate is 0.5-1%, of which orbital injury accounts for 0.09% due to direct trauma.2 We report a case of unilateral delayed sudden visual loss without orbital trauma observed intraoperatively or on post[1]operative imaging studies, following a seemingly routine endoscopic sinus surgery for chronic rhinosinusitis. CASE REPORT                    An 18-year-old lad with no significant medical history underwent ESS for bilateral chronic rhinosinusitis with nasal polyposis. (Figure 1 A-D) The surgery and recovery from anesthesia were uneventful. On the 12th hour post-operatively, the patient noted blurring of vision on the left. Ophthalmologic examination revealed hyperemic conjunctiva (Figure 2A) with visual acuity of counting fingers at 1 foot while fundoscopy showed retinal hemorrhages. Extraocular eye movements (EOM) and intraocular pressure (IOP) were normal (12mmHg). With an assessment of pre-retinal hemorrhages, 500 mg Tranexamic acid was intravenously infused, and a paranasal sinus (PNS) computed tomography (CT) scan and orbital magnetic resonance imaging (MRI) were requested. A few hours later, he complained of left eye pain with increasing intensity and further deterioration of vision. Repeat visual acuity testing showed light perception. There was now a constricted pupil, non-reactive pupillary light reflex, periorbital swelling and progression of conjunctival chemosis. (Figure 2B) The IOP of the left eye had increased to 30mmHg then progressed to 40mmHg with development of total visual loss and a lateral gaze limitation. With an impression of choroidal hemorrhage and retrobulbar hemorrhage, a lateral canthotomy relieved the eye pain.                The contrast PNS CT scan with orbital cuts showed that the lamina papyracea was intact with no definite hemorrhagic collections in the intraconal or extraconal spaces of both orbits. (Figure 3A, B) A small hyper density along the lateral inferior margin of the left globe at the intraconal region with slight thickening of the anterior periorbital region represented the lateral canthotomy. The PNS MRI / magnetic resonance angiography (MRA) with orbital cuts showed retinal detachment and periorbital edema in the left eye. (Figure 4) A B-Scan ocular ultrasonogram showed retinal detachment and vitreous opacities. The diagnosis was ocular ischemic syndrome secondary to ophthalmic artery vasospasm, and the patient was given sublingual nitroglycerine and intravenous dexamethasone 8mg every 12 hours for 24 hours, with improvement of periorbital swelling. He was discharged after 12 days with no resolution of the unilateral visual loss.

scholarly journals Loss of Visual Acuity after Successful Surgery for Macula-On Rhegmatogenous Retinal Detachment in a Prospective Multicentre Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Salvatore Di Lauro ◽  
Melissa Castrejón ◽  
Itziar Fernández ◽  
Jimena Rojas ◽  
Rosa M. Coco ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Visual Loss ◽  
Vision Loss ◽  
Multicentric Study ◽  
Prospective Multicentre Study ◽  
Snellen Chart ◽  
Pars Plana ◽  
Phakic Eyes

Purpose. To quantify the frequency of visual loss after successful retinal detachment (RD) surgery in macula-on patients in a multicentric, prospective series of RD.Methods. Clinical variables from consecutive macula-on RD patients were collected in a prospective multicentric study. Visual loss was defined as at least a reduction in one line in best corrected visual acuity (VA) with Snellen chart. The series were divided into 4 subgroups: (1) all macula-on eyes (n=357); (2) macula-on patients with visual loss at the third month of follow-up (n=53) which were further subdivided in (3) phakic eyes (n=39); and (4) pseudophakic eyes (n=14).Results. Fifty-three eyes (14.9%) had visual loss three months after surgery (n=39phakic eyes;n=14pseudophakic eyes). There were no statistically significant differences between them regarding their clinical characteristics. Pars plana vitrectomy (PPV) was used in 67.2% of cases, scleral buckle in 57.7%, and scleral explant in 11.9% (36.1% were combined procedures).Conclusions. Around 15% of macula-on RD eyes lose VA after successful surgery. Development of cataracts may be one cause in phakic eyes, but vision loss in pseudophakic eyes could have other explanations such as the effect of released factors produced by retinal ischemia on the macula area. Further investigations are necessary to elucidate this hypothesis.

scholarly journals A 16-Year Study on Incidence and Progression of Diseased Sphenoethmoidal (Onodi) Cell

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ethan I. Huang ◽  
Chia-Ling Kuo ◽  
Li-Wen Lee
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Optic Nerve ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Sinus Surgery ◽  
Acute Visual Loss ◽  
Computed Tomography Images ◽  
Onodi Cell

Traumatic operative injury of the optic nerve in an endoscopic sinus surgery may cause immediate or delayed blindness. It should be cautioned when operating in a sphenoethmoidal cell, or known as Onodi cell, with contact or bulge of the optic canal. It remains unclear how frequent progression to visual loss occurs and how long it progresses to visual loss because of a diseased sphenoethmoidal cell. Research to discuss these questions is expected to help decision making to treat diseased sphenoethmoidal cells. From July 2001 to June 2017, 216 patients received conservative endoscopic sinus surgery without opening a diseased sphenoethmoidal cell. We used their computed tomography images of paranasal sinuses to identify diseased sphenoethmoidal cells that could be associated with progression to visual loss. Among the 216 patients, 52.3% had at least one sphenoethmoidal cell, and 14.8% developed at least one diseased sphenoethmoidal cell. One patient developed acute visual loss 4412 days after the first computed tomography. Our results show that over half of the patients have a sphenoethmoidal cell but suggest a rare incidence of a diseased sphenoethmoidal cell progressing to visual loss during the follow-up period.

scholarly journals A Case of Transient Visual Disturbance and Ocular Paresis after Endoscopic Sinus Surgery

2020 ◽  
Vol 27 (1) ◽  
pp. 46-49
Author(s):  
Ji Soo Lee ◽  
Jeong Hwan Yang ◽  
Joong Seob Lee
Keyword(s):  
Surgical Treatment ◽  
Chronic Rhinosinusitis ◽  
Local Anesthetics ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Visual Disturbance ◽  
Sinus Surgery ◽  
Ocular Muscle ◽  
Orbital Complications ◽  
Muscle Toxicity

Endoscopic sinus surgery (ESS) is widely used as standard surgical treatment for chronic rhinosinusitis. Orbital complications of varying degrees occurred during ESS have been widely reported. If the orbital symptoms occurred immediately after surgery, ocular damage associated with surgery is suspected if the patient’s preoperative ocular function was patent. If immediate action is not taken, permanent visual loss might develop, so it is very important to diagnose orbital complications and take appropriate action. In our case, there was no definite intraorbital hemorrhage when sudden visual loss was noted. The symptoms were fully recovered without further treatment and it is clinically suspected to be caused by transient ocular muscle toxicity of local anesthetics.

Orbital Complications in Functional Endoscopic Sinus Surgery

1993 ◽  
Vol 109 (5) ◽  
pp. 814-820 ◽  
Author(s):  
Jacquelynne P. Corey ◽  
Robert Bumsted ◽  
William Panje ◽  
Ari Namon
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Nasolacrimal Duct ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Previous Surgery ◽  
Steroid Use ◽  
Orbital Complications ◽  
Lateral Canthotomy

Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications—including retroorbital hematoma—are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A “management” tree of decision parameters relevant to orbital complications is presented.

scholarly journals Concomitant orbital and intracranial abscess

2020 ◽  
pp. 189-194
Author(s):  
Andreea Nae ◽  
Stephen Farrell ◽  
Kieron Sweeney ◽  
Siobhan Hoare ◽  
Michael Colreavy
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pediatric Population ◽  
Sinus Surgery ◽  
Intracranial Abscess ◽  
Case Presentation ◽  
Intravenous Antibiotics ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Team Setting ◽  
Periorbital Swelling

Background:  Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae. Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks. Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting. We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.

Effect of Sinus Surgery on Visual Disturbance Caused by Spheno-ethmoid Mucoceles

1997 ◽  
Vol 11 (5) ◽  
pp. 337-344 ◽  
Author(s):  
Eiji Yumoto ◽  
Masamitsu Hyodo ◽  
Seiji Kawakita ◽  
Ryuichi Aibara
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Visual Loss ◽  
Visual Disturbance ◽  
The Other ◽  
Sinus Surgery ◽  
Bony Defect ◽  
Blurred Vision ◽  
Severe Visual Loss ◽  
Sphenoid Sinuses

Fifteen patients suffering from visual disturbance of varying degrees caused by a mucocele of the posterior ethmoid and/or sphenoid sinuses underwent marsupialization of a mucocele into the nasal cavity. Five of the eight patients with severe visual loss worse than 20/200 showed recovery of measurable vision. Two of these five were operated on within 24 hours after the onset of visual loss and showed marked recovery to 20/25 and 20/15. The other seven patients who had relatively mild visual disturbance experienced improvement of visual acuity or remission of subjective complaints such as blurred vision postoperatively. During operation partial bony defect was found in the optic canal in 12 patients and in the skull base in 12 patients. A good understanding of this disease by ophthalmologists and otolaryngologists is essential for early diagnosis and prompt surgical treatment to avoid permanent visual dysfunction and operative sequelae.

scholarly journals Rapid and spontaneous resolution of hemorrhagic macular hole retinal detachment and subretinal hemorrhages in an eye with pathologic myopia: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Taiju Ito ◽  
Tae Igarashi-Yokoi ◽  
Kosei Shinohara ◽  
Takeshi Yoshida ◽  
Kyoko Ohno-Matsui
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Hole ◽  
Spontaneous Resolution ◽  
Pathologic Myopia ◽  
Retinal Hemorrhages ◽  
Swept Source ◽  
Anti Vegf ◽  
Macular Hole Retinal Detachment ◽  
Myopic Cnv

Abstract Background To report a rare case of pathologic myopia in which a choroidal neovascularization (CNV) induced a hemorrhagic macular hole retinal detachment (MHRD), and then both the CNV and MHRD disappeared simultaneously in 5 days. Case presentation A 76-year-old man with pathologic myopia complained of distorted vision in his left eye of 1-week duration. The visual acuity in the left eye was 20/20 and the axial length was 31.0 mm. Ophthalmoscopic examinations of the left eye showed many retinal hemorrhages and whitish lesions on a background of severe diffuse myopic atrophy. Swept-source OCT (SS-OCT) showed multiple hyperreflective vertical finger-like projections extending into the outer retina that corresponded to the area of the botryoidal-shaped retinal hemorrhages. The SS-OCT images also showed many subretinal infiltrations adjacent to linear retinal hemorrhages with a disruption of the adjacent ellipsoid zone of the photoreceptors. Fluorescein angiography (FA) showed early hyperfluorescence and late leakages corresponding to the areas of the hemorrhages or adjacent to the linear retinal hemorrhages. These results suggested that the development of the inflammatory CNV was related to the outer retinopathy or choroiditis as in eyes with punctate inner choroidopathy or multifocal choroiditis rather than myopic CNV. We planned an intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection but the patient noticed a sudden reduction of the visual acuity a few days before the anti-VEGF injection. The left fundus showed a MHRD due to the subretinal hemorrhage. Five days later, the SS-OCT images confirmed a recession of the CNV and a resolution of the MHRD. Conclusions Rapid and spontaneous resolution of both myopic CNV and hemorrhagic MHRD suggest that there may have been a mutual mechanism causing the MHRD and CNV. A careful follow-up before doing surgery may be a choice for hemorrhagic MHRD in eyes with pathologic myopia.

Optic Neuritis following Endoscopic Sinus Surgery

1993 ◽  
Vol 7 (6) ◽  
pp. 247-256
Author(s):  
Perry J. Johnson ◽  
James V. Huerter ◽  
John D. Peters ◽  
Richard H. Legge
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Optic Neuritis ◽  
Endoscopic Sinus Surgery ◽  
Visual Loss ◽  
Sinus Surgery ◽  
High Dose ◽  
Inflammatory Condition ◽  
Rule Out

A case report of optic neuritis, a previously unreported complication following endoscopic sinus surgery, is presented with a review of the diagnosis, postulated pathophysiology, and treatment. Optic neuritis is an inflammatory condition involving the optic nerve and should be considered in the differential diagnosis inpatients who present with ocular complaints following endoscopic sinus surgery. Aggressive evaluation including computed tomography of the orbit and paranasal sinuses to rule out retroorbital hematoma, abscess or bony dehiscence, as well as ophthalmology consultation is essential. Prompt recognition of optic neuritis and institution of high dose corticosteroids and antibiotics may prevent visual loss.

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