We reviewed medical records of 910 patients on whom we performed 1600
endoscopic sinus procedures between June 1987 and December 1991 to det
ermine the incidence of orbital penetration during endoscopic sinus su
rgery. We examined this incidence in relation to the area of the orbit
penetrated, sequelae, and responsible surgical maneuver during the pr
ocedure. Orbital entry was documented in 33 procedures in 32 patients.
All procedures were videotaped and these tapes were reviewed. The are
a of the orbit most often violated was anterior to the anterior ethmoi
d artery and the front face of the ethmoid bulla. No sequelae occurred
in 12 patients, preseptal periorbital ecchymosis occurred in 17 cases
, subcutaneous emphysema occurred in 3 cases, and the only serious seq
uelae, retrobulbar hematoma, occurred with violation of the lamina pap
yracea in the region of the anterior ethmoid artery in 1 case. We foun
d that complications occurred most often with removal of the uncinate
process in patients with a deviated septum and a lateralized middle tu
rbinate. In such patients, for uncinectomy, we deflect the uncinate pr
ocess medially with a curved ball probe placed through the semilunar h
iatus and directed into the infundibulum. With this revision of our te
chnique for removal of the uncinate process, the incidence of orbital
penetration dropped to zero.