Concomitant lateral gaze limitation and mydriasis during sinus surgery

Concomitant Lateral Gaze Limitation and Mydriasis During Sinus Surgery. Problem: Orbital complications (eg, proptosis and loss of vision) may develop rapidly during functional endoscopic sinus surgery (FESS) under local anesthesia. Case: A 51-year-old man undergoing FESS for recurrent chronic sinusitis complained of blurred vision and diplopia during surgery. The operation was stopped immediately. Physical examination revealed that movement of the right eye was limited in terms of the abduction and dilatation of the right pupil. Magnetic resonance imaging and an ophthalmologic consultation were ordered. Finally, a clinical diagnosis was made of short ciliary and abducens nerve palsy caused by injection of the sphenopalatine block. Conclusion: We report the first case of concomitant lateral gaze limitation and mydriasis due to the inadvertent injection of anesthesia into the short ciliary and abducens nerve. The patient’s prognosis was good; however, every complication can be burdensome to the surgeon. More attention should be paid to avoid such complications when performing local infiltration.