Delayed orbital infection after endoscopic orbital decompression for dysthyroid orbitopathy

Objective: To present a delayed complication of endoscopic orbital decompre ssion that has not been reported previously in the literature. Design: Retrospective non-comparative small case series. Participants: Three patients with dysthyroid orbitopathy. Intervention: The medical records of patients with dysthyroid orbitopathy w ho underwent endoscopic orbital decompression and subsequently developed or bital infection were reviewed. Results: Three patients with dysthyroid orbitopathy developed orbital infec tion (cellulitis or abscess) originating from the frontal sinus more than 2 years after their endoscopic orbital decompression surgery. Management req uired drainage of the abscess, administration of antibiotics, and creation of adequate frontal sinus drainage. Conclusions: Delayed orbital infection can occur after endoscopic orbital d ecompression for dysthyroid orbitopathy when the frontal sinus ostium is ob structed by orbital fat or scar tissue, infection within the frontal sinus can cause secondary orbital cellulitis or abscess. Early signs and symptoms of a frontal sinus infection can be easily misdiagnosed as progression of the patient's thyroid eye disease. Awareness of this possible complication followed by appropriate early intervention will prevent a potentially blind ing condition. Furthermore, ever since this complication was observed, the authors' surgical technique of endoscopic decompression has been modified t o leave the most anterosuperior portion of the lamina papyracea to prevent fat prolapse and scar formation into the region of the frontal recess. (C) 2000 by the American Academy of Ophthalmology.