Kaeser P-F, Klainguti G
Hôpital ophtalmique Jules-Gonin, avenue de France 15, 1004 Lausanne, Suisse.
J Fr Ophtalmol. 2012 Nov;35(9):684-9. doi: 10.1016/j.jfo.2011.11.011. Epub 2012 Jul 21.
Orbital wall fracture may occur during endoscopic sinus surgery, resulting in oculomotor disorders. We report the management of four cases presenting with this surgical complication.
A non-comparative observational retrospective study was carried out on four patients presenting with diplopia after endoscopic ethmoidal sinus surgery. All patients underwent full ophthalmologic and orthoptic examination as well as orbital imaging.
All four patients presented with diplopia secondary to a medial rectus lesion confirmed by orbital imaging. A large horizontal deviation as well as limitation of adduction was present in all cases. Surgical management consisted of conventional recession-resection procedures in three cases and muscle transposition in one patient. A useful field of binocular single vision was restored in two of the four patients.
Orbital injury may occur during endoscopic sinus surgery and cause diplopia, usually secondary to medial rectus involvement due to the proximity of this muscle to the lamina papyracea of the ethmoid bone. Surgical management is based on orbital imaging, duration of the lesion, evaluation of anterior segment vasculature, results of forced duction testing and intraoperative findings. In most cases, treatment is aimed at the symptoms rather than the cause, and the functional prognosis remains guarded.
眼眶壁骨折可能在内镜鼻窦手术期间发生，导致动眼障碍。我们报告4例出现这种手术并发症的处理情况。
对4例经鼻内镜筛窦手术后出现复视的患者进行了一项非对照观察性回顾性研究。所有患者均接受了全面的眼科和视光学检查以及眼眶成像检查。
所有4例患者均出现复视，眼眶成像证实为内直肌损伤所致。所有病例均存在明显的水平斜视以及内收受限。手术治疗包括3例行传统的徙后-徙前手术，1例行肌肉转位术。4例患者中有2例恢复了有用的双眼单视视野。
眼眶损伤可能发生在内镜鼻窦手术期间并导致复视，通常是由于内直肌靠近筛骨纸样板而受累。手术治疗基于眼眶成像、损伤持续时间、眼前段血管系统评估、被动牵拉试验结果和术中发现。在大多数情况下，治疗针对的是症状而非病因，功能预后仍不乐观。
