Hematoma orbitario secundario a cirugía endoscópica nasosinusal / Orbital hematoma secondary to endoscopic sinus surgery

Resumen Durante la cirugía endoscópica nasosinusal, la sección inadvertida y retracción hacia la órbita de la arteria etmoidal anterior (AEA) es el mecanismo habitual del hematoma orbitario (HO); éste se manifiesta con proptosis, dolor y déficit visual potencialmente irreversible. El déficit visual es secundario a isquemia del nervio óptico por aumento de la presión intraocular, siendo suficientes treinta minutos para que ocurra daño visual permanente. Por sus secuelas el tratamiento del HO debe ser rápido y agresivo. Presentamos el caso de un varón de 72 años con diagnóstico de rinosinusitis crónica con pólipos nasales refractaria a tratamiento médico que se sometió a cirugía endoscópica nasal y que desarrolló en el posoperatorio inmediato con un HO. Se manejó precozmente con cantotomía-cantolisis, descompresión orbitaria medial endoscópica y control vascular de la AEA. El paciente evoluciona favorablemente, sin déficit visual. En este artículo se discutirán el diagnóstico y manejo oportunos del hematoma orbitario iatrogénico.

Abstract During endoscopic sinonasal surgery, inadvertent section of the anterior ethmoidal artery (AEA) with retraction into the orbit is the usual mechanism of orbital hematoma (OH), leading to proptosis, pain, and potentially irreversible visual loss. Thirty minutes is sufficient for retinal ischemia and permanent visual loss. The explanation for blindness is due to increased intraorbital pressure. The treatment of iatrogenic HO must be quick and aggressive, because if it is not managed in time, it can cause a permanent visual deficit. We present the case of a 72-year-old man with a diagnosis of chronic rhinosinusitis with nasal polyps refractory to medical treatment who underwent nasal endoscopic surgery, evolving in the immediate postoperative period with an HO, requiring canthotomy - cantolysis and early surgical reintervention for endoscopic medial orbital decompression and vascular control of AEA. The patient evolves favorably, without visual deficit. This article will discuss the timely diagnosis and management of iatrogenic orbital hematoma.

A Case of Retrobulbar Hematoma after Septal Surgery Under General Anesthesia / 대한이비인후과학회지

Retrobulbar hematoma is a rare complication following septal surgery under general anesthesia. Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the right retrobulbar hematoma after septal surgery. At present, there is no literature about the occurrence of retrobulbar hematoma following septal surgery. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.

Retrobulbar Hematoma after Infraorbital Nerve Block in Trigeminal Neuralgia: A case report

Retrobulbar hematoma can arise from orbital trauma and periorbital or intraorbital procedures, and it can result in several morbidities including vision loss. Making the immediate diagnosis and performing decompression of the retrobulbar hematoma are crucial for preventing serious morbidities such as permanent vision loss. We present here a case of temporary vision loss that was due to iatrogenic retrobulbar hematoma in a patient who received infraorbital nerve block for the treatment of trigeminal neuralgia. A 70-year-old woman with trigeminal neuralgia was treated with infraorbital nerve block. Just after the procedure she experienced acute periorbital swelling, proptosis and worsening visual acuity. Immediate orbital computed tomography was done, and this revealed a retrobulbar hematoma. The patient underwent lateral canthotomy with cantholysis and administration of dexamethasone and mannitol. Improvement of visual acuity began 3 hours after these procedures. Her visual acuity was greatly improved 12 days after admission.

Clinical Experience of Retrobulbar Hematoma in Closed Reduction of Zygoma Fracture

Retrobulbar hematoma is a rare condition caused by direct trauma and postopertive complication. But, if prompt treatments delayed, retobular hematoma can cause catastrophic loss of vision. Proposed mechanism of visual loss by retrobulbar hematoma are increased intraocular pressure, retinal ischemia secondary to central artery occlusion, optic nerve compression and resultant ischemia. When retobulbar hematoma is suspected, medical and surgical treatment are needed. Which includes intravenous osmotic agents, acetazolamide, and beta-blocker eyedrops and prompt surgical exploration, such as lateral canthotomy. We report a case of retrobular hematoma occurred in closed reduction on zygoma fracture of 56-years-old female. In operation, abrrupt mydriasis, exophthalmos, and chemosis are detected and eyeball movement restriction observed. so we consulted these situation to ophthalmologist. He examined the patient and diagnosed as retrobulbar hematoma. So we ceased operation and incised lateral canthotomy promptly and solumedrol 500mg, 15% mannitol 500ml injected intravenously. Postoperative 2 days later, periorbital swelling and chemosis still remained, but mydriasis and eyeball movement restriction are disappeared.

A Case of Horner's Syndrome with Temporary Compressive Optic Neuropathy after Endoscopic Sinus Surgery / 대한이비인후과학회지

Retrobulbar hematoma is one of the major complications following endoscopic sinus surgery (ESS). Symptoms and physical findings include temporary blindness, ophthalmoplegia, mydriasis, ptosis, proptosis and eyelid ecchymosis. Recently, we experienced a rare case of the left Horner's syndrome with compressive optic neuropathy resulting from bilateral delayed retrobulbar hematoma after ESS. There is no literature about the Horner's syndrome as a complication of ESS at present. We hereby present this case with an emphasis on the importance of prevention, identification and management of retrobulbar hematoma.