Optic nerve injury following FESS

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

Post FESS with marked right periorbital swelling and loss of vision of the right eye.

Patient Data

Age: 50 years.
Gender: Female

A sizable defect was made within the right lamina papyracea. The continuity of the corresponding underlying medial rectus could not be identified. Two small bone fragments are seen intraorbital.The mid portion of retrobulbar part of the right optic nerve could not be assessed properly following FESS. An illdefined hyperdense feature is seen within the right retrobulbar fat likely retrobulbar hematoma.Slight forward protrusion of the right eye ball.

Limited MRI examination of the orbits showing discontinuity of the right optic nerve following FESS.

Case Discussion

Complications resulting from FESS are mainly temporary and reversible, but the major complications may cause serious disability. The Major orbital complications after functional endoscopic sinus surgery are rare. One of them is the most serious is optic nerve injury with consequent visual loss. The resultant serious complication of FESS may be blindness, diplopia, and cerebrospinal rhinorrhea.

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