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Major orbital complications of endoscopic sinus surgery
  1. NIHAL B KENAWY
  1. Bristol Eye Hospital
  2. University of Bristol
  1. MR OMAR M AYOU
  1. Bristol Eye Hospital
  2. University of Bristol
  1. Dr Kenawy nkenawy{at}yahoo.co.uk

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Editor,—We read with interest the article by Reneet al. 1 We would like to clarify a few points regarding endoscopic sinus surgery. Endoscopic sinus surgery is considered by many to be the most exciting development in otolaryngology. The aim is to restore the natural mucociliary clearance mechanism, drainage, and aeration of the sinuses by a minimally invasive technique, maintaining as much of the normal anatomy as possible.2 We agree with the authors that the incidence of ocular complications is low and similar to those reported by other non-endoscopic approaches.3 The authors mentioned CT scanning as a preoperative measure to reduce complications; this is a well established practice in all departments that practise endoscopic sinus surgery. Orbital complications are more likely to occur in patients with extensive polyposis especially those who had multiple surgery; however, in a survey of British otolaryngologists4 the overall estimated complication rate was 0.24%. As a matter of fact endoscopic sinus surgery techniques are being used to treat orbital complications such as malignant exophthalmos in thyroid eye disease.5 We believe that the key to avoiding such complications is the adequate understanding of the nasal anatomy endoscopically, which is only achieved through attending specialised workshops that are widely available throughout the country; adequate haemostasis intraoperatively is of paramount importance. If complications are encountered then the immediate termination of the procedure is recommended and an urgent ophthalmological opinion should be sought.

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