J Neurol Surg B Skull Base 2020; 81(04): 381-384
DOI: 10.1055/s-0040-1714077
Surgical Approaches to the Orbit
Review Article

Principles of Protection of the Eye and Vision in Orbital Surgery

Jenny C. Dohlman
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
,
Michael K. Yoon
1   Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations

Abstract

Orbital surgery can result in damage to ocular and orbital structures, leading to a range of structural and visual sequelae, including corneal abrasions, globe malposition, diplopia, and blindness. Vision loss in particular is the most feared and devastating complication, occurs with an overall incidence of 0.84%, and can occur secondary to direct injury, optic nerve compression, or ischemic events. Different types of orbital surgery and surgical approaches carry their own hazards, and it is important to be mindful of these risks in addition to having a thorough understanding of individual risk factors and anatomical variations for each patient. Although universal guidelines for preserving vision in orbital surgery do not yet exist, there are concrete steps that every surgeon can take at the preoperative, intraoperative, and postoperative stages to minimize the risk of injury and maximize the likelihood of preserving the eye and visual function.



Publication History

Article published online:
07 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Ord RA. Post-operative retrobulbar haemorrhage and blindness complicating trauma surgery. Br J Oral Surg 1981; 19 (03) 202-207
  • 2 Long JC, Ellis PP. Total unilateral visual loss following orbital surgery. Am J Ophthalmol 1971; 71 (1 Pt 2): 218-220
  • 3 Edelstein C, Goldberg RA, Rubino G. Unilateral blindness after ipsilateral prophylactic transcranial optic canal decompression for fibrous dysplasia. Am J Ophthalmol 1998; 126 (03) 469-471
  • 4 Jacobs SM, McInnis CP, Kapeles M, Chang S-H. Incidence, risk factors, and management of blindness after orbital surgery. Ophthalmology 2018; 125 (07) 1100-1108
  • 5 Kansakar P, Sundar G. Vision loss associated with orbital surgery - a major review. Orbit 2020; 39 (03) 197-208
  • 6 Chang JR, Grant MP, Merbs SL. Enucleation as endoscopic sinus surgery complication. JAMA Ophthalmol 2015; 133 (07) 850-852
  • 7 Jefferis JM, Jones RK, Currie ZI, Tan JH, Salvi SM. Orbital decompression for thyroid eye disease: methods, outcomes, and complications. Eye (Lond) 2018; 32 (03) 626-636
  • 8 Gavin Clavero MA, Simón Sanz MV, Til AM, Jariod Ferrer ÚM. Factors influencing postsurgical diplopia in orbital floor fractures and prevalence of other complications in a series of cases. J Oral Maxillofac Surg 2018; 76 (08) 1725-1733
  • 9 Dunya IM, Salman SD, Shore JW. Ophthalmic complications of endoscopic ethmoid surgery and their management. Am J Otolaryngol 1996; 17 (05) 322-331
  • 10 Rene C, Rose GE, Lenthall R, Moseley I. Major orbital complications of endoscopic sinus surgery. Br J Ophthalmol 2001; 85 (05) 598-603
  • 11 Lim JC, Hadfield PJ, Ghiacy S, Bleach NR. Medial orbital protrusion--a potentially hazardous anomaly during endoscopic sinus surgery. J Laryngol Otol 1999; 113 (08) 754-755
  • 12 Bonavolontà G. Postoperative blindness following orbital surgery. Orbit 2005; 24 (03) 195-200
  • 13 Purgason PA, Hornblass A. Complications of surgery for orbital tumors. Ophthal Plast Reconstr Surg 1992; 8 (02) 88-93
  • 14 Bhatti MT, Stankiewicz JA. Ophthalmic complications of endoscopic sinus surgery. Surv Ophthalmol 2003; 48 (04) 389-402
  • 15 Shriver EM, Bartley GB. Vision loss in orbital surgery: a call to action for orbital surgeons. Ophthalmology 2018; 125 (07) 1109
  • 16 Gosau M, Schöneich M, Draenert FG, Ettl T, Driemel O, Reichert TE. Retrospective analysis of orbital floor fractures--complications, outcome, and review of literature. Clin Oral Investig 2011; 15 (03) 305-313
  • 17 Girotto JA, Gamble WB, Robertson B. et al. Blindness after reduction of facial fractures. Plast Reconstr Surg 1998; 102 (06) 1821-1834
  • 18 Gerbino G, Ramieri GA, Nasi A. Diagnosis and treatment of retrobulbar haematomas following blunt orbital trauma: a description of eight cases. Int J Oral Maxillofac Surg 2005; 34 (02) 127-131
  • 19 Hoşal BM, Beatty RL. Diplopia and enophthalmos after surgical repair of blowout fracture. Orbit 2002; 21 (01) 27-33