Sequential Correction for Large Exotropia: A Case of Iatrogenic Exotropia Developed after Excision of Medial Rectus Muscle During Functional Endoscopic Sinus Surgery (FESS)

AbstractObjectivesThis prospective, epidemiological British Ophthalmological Surveillance Unit study into ophthalmic complications of functional endoscopic sinus surgery aimed to determine the minimum incidence, presenting features and management throughout the UK.MethodsCases of ophthalmic complications of functional endoscopic sinus surgery, between February 2016 and February 2018, were identified through the British Ophthalmological Surveillance Unit reporting card system. Reporting ophthalmic consultants were sent an initial questionnaire, followed by a second questionnaire at six months.ResultsTwenty-six cases of ophthalmic complications of functional endoscopic sinus surgery were reported. The majority (16 cases (62 per cent)) had limitations of ocular motility at presentation. The most common final diagnosis was rectus muscle (33 per cent) and nasolacrimal duct trauma (27 per cent). Using national data, this study reports a minimum incidence of ophthalmic complications of functional endoscopic sinus surgery in the UK of 0.2 per cent over two years.ConclusionIn terms of ophthalmic complications, functional endoscopic sinus surgery is shown to be safe. Ophthalmic complications are rare, but when they do occur, they commonly result in rectus muscle trauma, often requiring surgical intervention.

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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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Vertical Rectus Muscles Transposition in Large Exotropia with Medial Rectus Muscle Transection Following Endoscopic Sinus Surgery

Korean Journal of Ophthalmology ◽

10.3341/kjo.2008.22.2.104 ◽

2008 ◽

Vol 22 (2) ◽

pp. 104 ◽

Cited By ~ 4

Author(s):

Cho Yoonae A. ◽

Sang Hoon Rah ◽

Myung Mi Kim ◽

Joo Yeon Lee

Keyword(s):

Endoscopic Sinus Surgery ◽

Rectus Muscle ◽

Sinus Surgery ◽

Medial Rectus

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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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