Delayed orbital infection after endoscopic orbital decompression for dysthyroid orbitopathy.
OBJECTIVE
To present a delayed complication of endoscopic orbital decompression that has not been reported previously in the literature.


METHODS
Retrospective non-comparative small case series.


METHODS
Three patients with dysthyroid orbitopathy.


METHODS
The medical records of patients with dysthyroid orbitopathy who underwent endoscopic orbital decompression and subsequently developed orbital infection were reviewed.


RESULTS
Three patients with dysthyroid orbitopathy developed orbital infection (cellulitis or abscess) originating from the frontal sinus more than 2 years after their endoscopic orbital decompression surgery. Management required drainage of the abscess, administration of antibiotics, and creation of adequate frontal sinus drainage.


CONCLUSIONS
Delayed orbital infection can occur after endoscopic orbital decompression for dysthyroid orbitopathy when the frontal sinus ostium is obstructed by orbital fat or scar tissue. Infection within the frontal sinus can cause secondary orbital cellulitis or abscess. Early signs and symptoms of a frontal sinus infection can be easily misdiagnosed as progression of the patient's thyroid eye disease. Awareness of this possible complication followed by appropriate early intervention will prevent a potentially blinding condition. Furthermore, ever since this complication was observed, the authors' surgical technique of endoscopic decompression has been modified to leave the most anterosuperior portion of the lamina papyracea to prevent fat prolapse and scar formation into the region of the frontal recess.
Remulla
H D
HD
Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
Gliklich
R E
RE
Metson
R
R
Rubin
P A
PA
D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D019299:Decompression, Surgical / Q000009:adverse effects*; D004322:Drainage / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects*; D015817:Eye Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D005260:Female; D006111:Graves Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009915:Orbit / Q000000981:diagnostic imaging / Q000601:surgery*; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents