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<p>Retro-orbital hemorrhage (ROH) following functional endoscopic sinus surgery (FESS) can be either arterial or venous in origin. While arterial ROH is acute and well-recognized, venous ROH progresses slowly and may cause irreversible vision loss if not identified early. Due to very limited literature on venous ROH, we present two rare cases highlighting distinct clinical predictors and pathophysiological mechanisms such as old healed CSF leak, hypertensive status, tight postoperative intranasal packing, long-standing anosmia following suspected trauma, and malignant nasal tumor infiltrating in orbit. Both experienced visual deterioration following FESS, underlining the importance of early recognition and tailored intraoperative and postoperative management. Our findings suggest that avoiding tight intranasal packing when the lamina papyracea is compromised and initiating corticosteroid therapy promptly in high-risk cases are critical to prevent visual sequelae.</p>

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Venous Haemorrhage Following Functional Endoscopic Sinus Surgery: Determinants of Threatening Vision

  • 期刊论文

  • 发表日期：

    2025年8月19日

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  • Verma Parul,
  • Mishra Anupam

摘要

Retro-orbital hemorrhage (ROH) following functional endoscopic sinus surgery (FESS) can be either arterial or venous in origin. While arterial ROH is acute and well-recognized, venous ROH progresses slowly and may cause irreversible vision loss if not identified early. Due to very limited literature on venous ROH, we present two rare cases highlighting distinct clinical predictors and pathophysiological mechanisms such as old healed CSF leak, hypertensive status, tight postoperative intranasal packing, long-standing anosmia following suspected trauma, and malignant nasal tumor infiltrating in orbit. Both experienced visual deterioration following FESS, underlining the importance of early recognition and tailored intraoperative and postoperative management. Our findings suggest that avoiding tight intranasal packing when the lamina papyracea is compromised and initiating corticosteroid therapy promptly in high-risk cases are critical to prevent visual sequelae.