Medial Rectus Muscle Injuries After Functional Endoscopic Sinus Surgery: A Case Study

TL;DR

A 61-year-old woman developed a rare eye complication after sinus surgery, requiring surgical and botulinum toxin treatments to manage her condition.

Contribution

This case study reports a rare medial rectus muscle injury following FESS and outlines a novel management approach combining surgery and botulinum toxin.

Findings

The patient experienced retrobulbar hemorrhage and medial rectus muscle hematoma after FESS.

Surgical exploration and botulinum toxin injection to the lateral rectus muscle improved the adduction deficit and diplopia.

Proper preoperative assessment is crucial to prevent and manage such rare orbital complications.

Abstract

Functional endoscopic sinus surgery (FESS) is the preferred method for managing obstructive sinus disorders. However, its proximity to the orbit poses a risk of orbital complications.

This study presents a case of a 61-year-old female who underwent FESS for chronic rhinosinusitis with nasal polyps and subsequently experienced a serious ophthalmic complication including retrobulbar hemorrhage and medial rectus muscle hematoma, leading to adduction deficit and diplopia.

The patient's condition was evaluated through clinical assessment and imaging studies, to address the extent and nature of the injury to the medial rectus muscle. Management strategies included surgical exploration and resection along with botulinum toxin injection to the lateral rectus muscle in the affected eye done six months after observation and regular ophthalmic examination to ensure the stability of the angle of deviation.

This case highlights the importance of proper preoperative assessment and personalized treatment plans to manage the complications associated with FESS and optimize patient outcomes.

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