Functional Endoscopic Sinus Surgery - FESS - Orbital Hematoma - Intraorbital Air
Functional Endoscopic Sinus Surgery - FESS Orbital Hematoma and Intraorbital Air

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   One of the uncommon but severe complications of endoscopic sinus surgery is Orbital Compartment Syndrome.  This can be caused by blood or rarely air which enters behind the eye.  As pressure increases permanent blindness may occur.  An orbital hematoma is caused when blood enters behind the orbit and slowly expands.  During surgery injury may occur to the bone lining the eye or blood vessels may be injured and retract into the orbit.  As the pressure builds, the eyelids swell and the eye bulges outward (proptosis) and the vision fades.  If treatment is not carried out immediately blindness may occur.

Treatment May Includes:

  • Nasal Packs are pulled and the globe is intermittently massage to try to slow the bleeding.
  • Manitol is given IV 1 to 2 grams per kilogram over 20-30 minutes
  • The lateral portion of the lower lid may be cut (lateral canthotomy) to relieve pressure.
  • Surgical Drainage of the hematoma.

The bone between the ethmoid sinus and the orbit (the bony cavity which houses the eye) is paper thin and is called the lamina papyracea (layer of paper).  During surgery, this layer may become cracked.  Forceful sneezing or blowing of the nose may cause air to enter the orbit causing proptosis and rarely blindness.  This is a self limiting disorder which will resolve on its own as the air is absorbed by the body.  However, if severe then the patent should be treated with orbital massage, manitol and, if loss of vision is eminent, a lateral canthotomy.  The patient should be instructed not to blow his/her nose and if the patient has to sneeze to sneeze with his/her mouth open. 

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