An ophthalmologic perspective on complications of functional endoscopic sinus surgery: a literature review

This review aims to highlight the ocular complications related to Functional Endoscopic Sinus Surgery (FESS) and provide insight for ophthalmologists and also otorhinolaryngologists.

A literature search was conducted on ophthalmic complications associated with FESS in the PubMed and Google Scholar databases. The keywords "endoscopic sinus surgery", "functional endoscopic sinus surgery", "paranasal sinuses", "orbita", "orbital complications", "orbital hemorrhage", "epiphora", "visual loss", "double vision", "optic nerve", "diplopia", "hematoma", "blindness", "oculomotor nerve", "lamina papyracea", "lacrimal drainage system", "ciliary ganglion", "extraocular muscles" were used.

Major complications include extraocular muscle injury, nasolacrimal duct injury, orbital hemorrhage, optic nerve injury, permanent vision loss, and injuries to the vascular and neural structures of the orbit. Orbital hemorrhage is among the most frequent ophthalmic complications of FESS and poses a potential threat to vision. It typically occurs due to penetration of the lamina papyracea into the orbit. Direct or indirect trauma to the optic nerve is one of the most devastating complications, resulting in irreversible vision loss, and there is currently no established treatment. Other complications include injuries to extraocular muscle, which must be managed on a case-by-case basis, and epiphora, which, although not vision-threatening, significantly reduces quality of life.

FESS has provided a new perspective on the surgical management of sinus diseases. While it is generally regarded as a safe procedure, the potential for complications should always be considered. The orbit and, therefore, the ocular tissues are susceptible to complications due to their critical anatomical relationships with the paranasal sinuses and skull base.