Complications of Orbital Surgery
The surgeon can reduce complications from orbital surgery by performing a complete preoperative evaluation with orbital imaging when indicated, choosing the appropriate surgical approach, obtaining adequate exposure, manipulating the tissues carefully, employing proper instrumentation and illumination, maintaining excellent hemostasis, and using a team approach when appropriate.
Decreased or lost vision is a serious complication of surgery that may be caused by excessive traction on the globe and optic nerve, contusion of the optic nerve, postoperative infection, or hemorrhage, which leads to increased orbital pressure and consequent ischemic injury to the optic nerve. A patient who has severe orbital pain postoperatively should be evaluated immediately for possible orbital hemorrhage. If this pain is associated with decreased vision, proptosis, ecchymosis, increased intraocular pressure, and an afferent pupillary defect, the surgeon should consider opening the wound to minimize the effects of orbital compartment syndrome (see Chapter 6 in this volume), evacuating any hematoma, and controlling active bleeding.
In addition to vision loss, possible complications after orbital surgery include:
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blepharoptosis
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cerebrospinal fluid leak
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ciliary ganglion dysfunction with loss of accommodation
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cranial neuropathy resulting in extraocular muscle weakness or palsy
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hypoesthesia in the distribution of the trigeminal nerve (divisions V1 and V2)
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infraplacement of the globe after decompression
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keratitis sicca
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motility disturbance resulting in diplopia
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neuroparalytic keratopathy
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orbital cellulitis
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pupillary dysfunction
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ret i nal detachment
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vitreous hemorrhage
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Ting DS, Perez-Lopez M, Chew NJ, Clarke L, Dickinson AJ, Neoh C. A 10-year review of orbital biopsy: the Newcastle Eye Centre Study. Eye (Lond). 2015;29(9):1162–1166.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.