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 Traumatic Globe Luxation

PURPOSE: The globe luxation is a rare phenomenon in which there is a forward displacement of the eye ball so that the eye lids spasmodically close behind it. In Korea, no case has been reported. The authors experienced a case of globe luxation by laceration of the conjunctiva with trauma. METHODS: The authors experienced a case of globe luxation in 64-year-old male who had crushed with infantile marry-go-round handle and complained proptosis and ocular pain. Ocular examination revealed best corrected visual acuity of right eye 0.1, IOP 44mmHg, conjunctival hyperemia and laceration, extraocular muscle limitation in all direction. Exophthalmometer shows right eye 23mm, left eye 19mm. Orbital CT yielded proptosis and globe luxation without avulsion of internal and external rectus muscle and optic nerve. RESULTS: After the lateral canthotomy, we successfully treated with the corticosteroid therapy without visual impairment or eyeball movement disorder. we report a case of globe luxation with the review of literature.

Transconjunctival Approach For The Treatment Of Orbital Trauma

The transconjunctival approach to a large retrobulbar cavernous hemangioma of the orbit

Cavernous hemangiomas are one of the most common benign tumors of the orbit in adults. We report a case of a longstanding retrobulbar hemangioma that was removed successfully through a temporal transconjunctival approach combined with lateral canthotomy. A 45-year-old female patient, with a 15-year history of slowly progressive proptosis and decreased visual acuity of the left eye, had a corrected visual acuity of finger count at 50 cm OS, compared with 1.0 OD. Exophthalmometry by the Nagle's method measured 15 mm OD by 26 mm OS. Magnetic resonance imaging (MRI) revealed a well-encapsulated retrobulbar main mass, 2.3 x 3.0 x 3.7 cm in size along with multiple small satellite nodules that were displacing the optic nerve and globe superiorly. The tumors were removed through a superotemporal transconjunctival approach combined with lateral canthotomy. Pathological examination revealed an intraorbital cavernous hemangioma. The patient was free of visible scars, proptosis and any other noticeable complications at her last follow-up, 6 months after surgery.

Treatment of Complete Traumatic Eyeball Extrusion

The authors have encountered two patients who had complete traumatic eyeball extrusion by trauma with different mechanism. One was a 2-year-old child who fell down from a baby stroller and had the left eyeball extrusion without any trauma to the body except eye. The other was 29-year-old man whose right orbit was pierced by a spit and had right eyeball extrusion too. After the authors reposed traumatic complete eyeball extrusion by Kronlein operation, lateral canthotomy, and antholysis, the authors obtained excellent cosmetic results. Especially, these are very rare cases of the pure eye ball extrusion without another trauma of the body. Therefore, the authors report the experience of the operative treatment of these rare cases.