Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery

Idit Maharshak,^1,2 Jenny K Hoang,³ M Tariq Bhatti<sup>2,4

1</sup>Department of Ophthalmology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; ²Department of Ophthalmology, ³Department of Radiology (Division of Neuroradiology), ⁴Department of Medicine (Division of Neurology), Duke Eye Center and Duke University Medical Center, Durham, NC, USA

Objective: To describe two rare cases of concurrent vision loss and external ophthalmoplegia following powered endoscopic sinus surgery (ESS).
Design: Observational case report.
Results: The records of two patients who underwent powered ESS and developed multiple concurrent ophthalmic complications were retrospectively reviewed for clinical history, neuro-ophthalmologic examination, and imaging findings. Patient 1 developed a retinal vascular occlusion and complete loss of adduction. Patient 2 developed an orbital hemorrhage, optic neuropathy, and a restrictive global ophthalmoplegia. Similar published case reports were also reviewed.
Conclusion: Despite advances in powered ESS technique and instrumentation, serious ophthalmic complications can still occur. Inadvertent entry into the medial orbital wall can result in a combination of blindness and ocular motility dysfunction. The variety of mechanisms responsible for these complications underscores the importance of thorough pre- and postoperative clinical examination and review of imaging studies.

Keywords: sinus surgery, orbit, extra ocular muscle injury, blindness