Management of orbital complications in endoscopic sinus surgery

Minor and major complications can occur during endoscopic sinus surgery. Even though major complications are rare, orbital complication is one of the more common major complications that can lead to devastating consequences. This article summarizes the orbital complications that can occur during endoscopic sinus surgery, how to manage the complication when it occurs, and more importantly how to avoid these complications.

One of the orbital complications during endoscopic sinus surgery is retrobulbar hematoma. Retrobulbar hematoma can be classified as spontaneous, traumatic, and iatrogenic. Iatrogenic hematoma, which can be caused by endoscopic sinus surgery, is more likely to have an arterial source, so these hematomas have higher tonometric pressure and may require more aggressive management. However, medical management can be an option for some of these iatrogenic retrobulbar hematomas. Tonometric pressure may be the best indicator to decide which intervention to use for this complication. Another distressing orbital complication is injury to the oculomotor muscles. With prompt medical and surgical intervention, the ocular dysmotility can be compensated.

Consequences of orbital injury during endoscopic sinus surgery can be devastating; however, with proper medical or surgical treatment potential morbidities can be minimized.