Major orbital complications of endoscopic sinus surgery

Background-The paranasal sinuses are intimately related to the orbit and co nsequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devas tating of which is severe visual loss. Methods-A retrospective review was undertaken of four cases of severe orbit al trauma during endoscopic sinus surgery. Results-All the cases suffered medial rectus damage, one had additional inj ury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply. Conclusion-Some ophthalmic complications of endoscopic sinus surgery are hi ghlighted, the mechanisms responsible are discussed, and recommendations fo r prevention, early recognition, and management are proposed.