Retro-orbital Hematoma Twenty-Four Hours after Endoscopic Sinus Surgery: A Case Report

The retro-orbital hematoma is a rare, but serious complication of endoscopic sinus and skull base surgery that must be quickly recognized and treated to avoid irreversible vision loss. This case report describes an otherwise healthy 45-year-old woman with 1 week of intractable frontal headaches and right eye erythema who was found to have a bullet lodged in her ethmoid bed obstructing the bilateral frontal sinuses, with fragments involving the cribriform plate and right lamina papyracea ([Fig. 1]). The bullet, as well as the obstructive bone fragments, was successfully removed through a transnasal endoscopic approach without complications. 24 hours after completion of the surgery, the patient developed a retro-orbital hematoma requiring bedside lateral canthotomy with rapid resolution of her elevated intraocular pressures. In the literature, retro-orbital hematomas are classically rapid and intraoperative, but onset can also be insidious and delayed. Otolaryngologists and neurosurgeons should maintain a high degree of vigilance and have a comprehensive understanding of the management of retro-orbital hematomas in the days following endoscopic surgeries of the skull base and sinuses, particularly if the patient's mechanism of injury or intraoperative course confers increased risk.

Fig. 1

Publication History

Article published online:
15 February 2022