The orbital contents may occasionally be damaged due to inadvertent entry into the orbit during endoscopic sinus surgery and may result in devastating complications, such as severe motility restriction or blindness (Figure 14.13). Direct damage to the orbital fat, muscles and, more rarely, optic nerve, may occur, especially during power-assisted debridement of diseased sinus tissues. The most important point in the management of inadvertent orbital entry is recognition and immediate cessation of further surgery; in particular the orbit should be observed for signs of traction on the orbital tissues and for small movements of the globe.
Injury to the ethmoidal arteries may result in orbital haemorrhage with compressive optic neuropathy and this may require anterior orbitotomy, drainage of the haematoma and diathermy of damaged vessels.
Orbital haemorrhage more commonly follows orbital surgery or after retrobulbar or peribulbar injections for intraocular and periocular surgery; it may also occur with blepharoplasty, when it is thought to arise from
traction damage to small deep orbital vessels. A venous bleed is of slower onset and will usually self tamponade with vision frequently recovering. Firm orbital pressure may assist tamponade and a lateral cantholysis after 5-10 minutes may assist reduction in intraorbital pressure after tamponade has occurred.
A rapid development of proptosis is likely to be arterial bleeding and should be dealt with by very firm orbital pressure applied for about 8-10 minutes, but being released for about 15 seconds every 2 minutes to allow ocular perfusion. If the orbital pressure rises to a very high level, with loss of eye movements and vision not attributable to local anaesthesia, then the orbit should be drained through a skin incision in the affected quadrant; once the skin is opened, a closed pair of blunt-ended scissors should be gently advanced about 3cm into the orbital fat of the affected quadrant and the blades gently opened to spread the tissues and encourage drainage of blood and tissue fluid. This manoeuvre is generally sufficient to release the orbital tamponade, with restoration of vision, and a drain should be placed until the bleeding has stopped.
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.