From the Guidelines
The correct answer is A: Orbital emphysema is dangerous to vision. Orbital emphysema occurs when air enters the orbital tissues following sinus surgery, particularly when there is communication between the sinuses and orbit due to fracture or surgical breach. This condition can be dangerous to vision because accumulated air can cause pressure within the orbit, potentially leading to compression of the optic nerve or central retinal artery, resulting in vision loss 1.
When managing complications of Functional Endoscopic Sinus Surgery (FESS), it's crucial to consider the potential for orbital injury. Key symptoms suggesting orbital involvement include eye swelling with or without proptosis, impaired eye movement, and decreased visual acuity 1.
In the case of suspected orbital injury during FESS, the management approach should prioritize minimizing further risk to vision.
- If orbital fat is exposed, tight packing with wet ribbon gauze should be avoided as it may increase intraorbital pressure.
- Mannitol is not routinely given intraoperatively for suspected orbital injury but may be considered postoperatively if significant orbital edema develops.
- Total intravenous anesthesia does not specifically reduce the risk of orbital injury during FESS.
- For visual assessment after suspected orbital injury, a complete ophthalmologic examination including visual acuity, pupillary responses, extraocular movements, and fundoscopy is necessary, rather than relying solely on Ishihara color testing 1.
Given the potential for serious complications, including vision loss, it's essential to approach FESS complications with caution and prioritize evidence-based management strategies to minimize morbidity and mortality, and preserve quality of life.
From the Research
FESS Complications
- Orbital emphysema is a potential complication of FESS, but there is limited information on its specific risks to vision 2.
- If orbital fat is exposed during FESS, the recommended management is to avoid further manipulation in the area and consider curtailing the extent of surgery 3.
- Packing the exposed area with wet ribbon gauze is not explicitly mentioned in the provided studies, but caution and careful management are emphasized 3.
- If an orbital injury is suspected, the use of mannitol may be considered to reduce intraocular pressure and orbital pressure 4, 5.
- Total intravenous anesthesia may not have a direct impact on reducing the risk of orbital injury during FESS, as the risk is more closely related to anatomical variations, disease severity, and surgical skill 2.
- If an orbital injury is suspected, performing an Ishihara test (a color vision test) may not be directly relevant to the management of the injury, but monitoring for vision changes and other complications is important 3, 2.