Managing double vision after functional endoscopic sinus surgery

This retrospective case series describes 6 patients who developed diplopia and strabismus after undergoing functional endoscopic sinus surgery (FESS).

Study design

Researchers analyzed medical charts to obtain information about medical examination, imaging studies, type of corrective surgery and surgical outcomes.

Outcomes

All 6 patients showed evidence of orbital trauma secondary to FESS, and 5 patients experienced medial rectus (MR) muscle transection. These 5 patients underwent immediate surgical intervention to recover the MR; however, none had a satisfactory outcome and they ultimately underwent vertical recti muscle transposition. The 6th patient had transient diplopia without evidence of extraocular muscle transection and recovered completely.

Limitations

Though the study addresses an uncommon but known complication of FESS, the number of patients reported is relatively small. The authors suggest that it is futile to attempt reattachment of the extraocular muscle in patients who demonstrate proven transection. While the authors are likely correct, it may be difficult to convince the patient and referring physician that no attempt should be made.

Clinical significance

The authors reinforce an observation that many oculoplastic surgeons have begrudgingly noted when caring for patients with transected rectus muscles secondary to FESS: Attempts at reattachment of the muscle usually do not produce satisfactory results. These cases usually present as an emergency with the possibility of subsequent litigation for the referring physician. This manuscript will be useful to cite when deciding not to perform additional surgery to find and reattach the muscle, and rather let the patient heal with the expectation of subsequent vertical muscle transposition strabismus surgery.