ORBITAL COMPLICATIONS IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY

Endoscopic sinus surgery can result in both minor and major complicati ons. Among these, orbital complications - including retroorbital hemat oma - are among the most feared. Injuries can be direct or indirect fr om pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in s even patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors m ay include hypertension, lamina papyracia dehiscences, extensive polyp oid disease, previous surgery, inability to visualize the maxillary os tia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, an d mannitol with ophthalmologic consultation. Opening of the wound by m eans of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisi ons into the periorbita should be added for fully effective relief. A ''management'' tree of decision parameters relevant to orbital complic ations is presented.