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Imtiaz A Chaudhry, Waleed Al-Rashed, Thomas M Bosley, Farrukh Shamsi, Yonca Arat; Ophthalmic Complications of Functional Endoscopic Sinus Surgery in Patients Presenting to a Tertiary Care Center. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3847.
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© ARVO (1962-2015); The Authors (2016-present)
To report severe ocular and periocular injuries caused by functional endoscopic sinus surgery (FESS) in patients seen at tertiary care center.
Clinical records of 26 patients who sustained severe ocular and periocular injuries during FESS were reviewed for presenting symptoms and signs, complications, management, and final outcome. Variables assessed included patient demographic data, reasons for FESS, operative findings, extent of ocular and periocular injuries and residual deficit.Main outcome measures included trauma caused by complications from the FESS, such as loss of vision and ocular and periocular injuries, and treatment rendered.
There were 16 males and 10 females with an average age of 35.4 years (range, 3 - 65 years). Presenting ocular and periocular symptoms and signs included, decrease or loss of vision in 12, diplopia and proptosis in 14, limitation of extraocular motility in 11, exotropia in 7, epiphora or discharge in 9, pain in 8, eyelid swelling in 8 and cerebrospinal fluid (CSF) leak in 3 patients. Fourteen sustained medial and/or orbital floor fractures, 11 suffered extraocular muscle injury (8 medial rectus muscle injury or transaction), 8 sustained optic nerve injury (1 bilateral), 8 had orbital cellulitis/abscess, and 9 patients sustained 3rd , 5th or 7th cranial nerve palsies. Twenty two patients required intervention that included, strabismus surgery in 9, drainage of orbital abscesses or hematoma in 8, optic canal decompression in 3, external dacryocystorhinostomies in 4, CSF leak repair in 2, and orbital wall fracture repair in 5 patients. After intervention, while vision improved in 4, 6 patients remained with no light perception vision (1 bilateral). Despite strabismus surgery, 8 continued to have some degree of residual ocular motility deficit.
Significant number of patients with severe complications related to FESS may continue to show functional impairment that may include complete loss of vision and persistent diplopia. Because of the close proximity of the ocular and adnexal structures to the sinuses, the risk for inadvertent injury during FESS may exist and patients should be advised regarding such complictions.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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