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   Table of Contents      
LETTER TO THE EDITOR
Year : 2016  |  Volume : 64  |  Issue : 9  |  Page : 697-698

Transient oculomotor nerve palsy after endoscopic sinus surgery


1 Department of Otolaryngology, School of Medicine, Kangwon National University, Kangwon, Chuncheon, Korea
2 Department of Ophthalmology, School of Medicine, Kangwon National University, Kangwon, Chuncheon, Korea

Date of Web Publication17-Nov-2016

Correspondence Address:
Prof. Moosang Kim
Department of Ophthalmology, School of Medicine, Kangwon National University Hospital, Baengnyeong-ro 156, Kangwon, Chuncheon 200-722
Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.194332

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How to cite this article:
Kim TS, Lee JH, Kim M. Transient oculomotor nerve palsy after endoscopic sinus surgery. Indian J Ophthalmol 2016;64:697-8

How to cite this URL:
Kim TS, Lee JH, Kim M. Transient oculomotor nerve palsy after endoscopic sinus surgery. Indian J Ophthalmol [serial online] 2016 [cited 2019 Aug 26];64:697-8. Available from: http://www.ijo.in/text.asp?2016/64/9/697/194332

Tae Su Kim, Jang Hun Lee
These authors contributed equally to this work.


Sir,

Endoscopic sinus surgery (ESS) is well-established as the mainstay of surgical treatment for refractory chronic rhinosinusitis. It is a minimally invasive and mucosa-preserving procedure with little patient morbidity. However, serious ophthalmological complications have been reported, such as orbital hemorrhage, blindness, and extraocular muscle injuries.[1],[2],[3] Oculomotor nerve palsy is extremely rare after ESS, and transient oculomotor nerve palsies after ESS have never been reported. We recently experienced an unusual case of transient oculomotor nerve palsy following ESS for nasal polyposis, thus herein report the case.

A 45-year-old woman underwent bilateral ESS for nasal polyposis. The patient complained of vertical diplopia after ESS. At initial presentation, her best-corrected visual acuities were 20/20 in both eyes (oculus utro [OU]). The anterior segment and media were normal, and funduscopic examination showed normal optic disc and macula OU. There was no relative afferent pupillary defect. Ophthalmological examination revealed evidence of the right oculomotor nerve palsy, with ptosis, limited adduction, supradduction and infradduction [Figure 1]. A postoperative computed tomography scan showed a dehiscence of the right lamina papyracea, adjacent to the posterior ethmoid sinus, with a protrusion of soft tissue [Figure 2]. The patient received systemic dexamethasone (30 mg/day for 2 weeks) for the treatment of her symptoms. Two weeks postoperatively, the ptosis of the right upper lid had completely recovered. She had regained full right ocular motility, with no diplopia [Figure 3].
Figure 1: Ptosis and limitation of elevation, depression, and adduction of the right eye consistent with oculomotor nerve palsy

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Figure 2: Axial computed tomography scan of the orbit after endoscopic sinus surgery, showing a dehiscence of lamina papyracea adjacent to the posterior ethmoid sinus

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Figure 3: Full recovery of eye movement and ptosis after 2 weeks of dexamethasone treatment

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The transient nature of our patient's oculomotor nerve palsy is curious. We postulate that the mechanism of oculomotor nerve palsy was focal contusion of the oculomotor nerve by blunt trauma that occurred while performing ethmoidotomy by force. Alternatively, ischemic nerve injury, due to disruption of the nerve's blood supply, may have been caused by the protrusion of soft tissue or the expanding packing in the ethmoid cavity. Extravasation of local anesthetic into the orbit from the sphenopalatine injection can result in transient mydriasis, ophthalmoplegia, and vision loss; however, this is unlikely to have occurred in our patient.

Oculomotor nerve palsy after ESS is a rare but significant complication. Our patient's spontaneous recovery indicates that an initial conservative approach may be appropriate in the absence of fat or muscle entrapment. Surgeons performing ESS must keep in mind the possibility of oculomotor nerve palsy due to blunt trauma, and must perform the whole procedure with great care, especially when operating close to the sphenoid and posterior ethmoid sinus.

Financial support and sponsorship

This study is supported by 2015 Research Grant from Kangwon National University (No. 520150330).

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Buus DR, Tse DT, Farris BK. Ophthalmic complications of sinus surgery. Ophthalmology 1990;97:612-9.  Back to cited text no. 1
    
2.
Bhatti MT, Stankiewicz JA. Ophthalmic complications of endoscopic sinus surgery. Surv Ophthalmol 2003;48:389-402.  Back to cited text no. 2
    
3.
Rene C, Rose GE, Lenthall R, Moseley I. Major orbital complications of endoscopic sinus surgery. Br J Ophthalmol 2001;85:598-603.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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