Acute Monocular Vision Loss Following Septoplasty With Bilateral Inferior Turbinate Radiofrequency Ablation: Operative Details, Differential, and Prevention
DOI:
https://doi.org/10.52340/GBMN.2025.01.01.140Keywords:
Inferior turbinate, orbital compartment syndrome, radiofrequency ablation, retinal artery occlusion, septoplastyAbstract
Ophthalmic complications after sinonasal surgery are uncommon but can be vision-threatening. We describe acute unilateral vision loss following septoplasty with bilateral inferior turbinate radiofrequency ablation (RFA), review the differential, and outline prevention strategies. Time-critical causes include orbital hemorrhage with orbital compartment syndrome (OCS), retinal arterial occlusions, and ischemic optic neuropathy; other considerations are direct injury to the optic nerve or extraocular muscles, orbital emphysema, and infection. A 26-year-old man underwent uneventful septoplasty with bilateral inferior turbinate RFA. Shortly after surgery, he developed acute monocular vision loss and received urgent ophthalmologic assessment. He was evaluated at two hospitals in Georgia and at a tertiary center in Israel; laboratory studies and computed tomography were non-diagnostic. Severe visual loss can follow routine septoplasty/turbinate RFA. Vision preservation depends on immediate recognition and protocolized response - especially for OCS and retinal arterial occlusion - and on preventive measures during surgery. Further research is needed to clarify the mechanisms and causal pathways of postoperative vision loss.References
Retrobulbar hemorrhage → Orbital compartment syndrome (OCS): Vision-threatening emergency; prompt lateral canthotomy/cantholysis improves outcomes when performed within 2 hours. Often arises from ethmoidal vessel injury.
CRAO/BRAO or retinal arterial vasospasm: Sudden, painless monocular loss has been reported after sinonasal surgery and rhinoplasty.
Ischemic optic neuropathy (AION/PION): Rarely reported after rhinologic procedures: perioperative hypotension, anemia, and hemodilution increase the risk for PION.
Optic nerve injury during ethmoid/sphenoid work.
Extraocular muscle (medial rectus) injury causing diplopia and functional compromise.
Orbital/periorbital emphysema with sight-threatening sequelae reported after FESS.
Orbital cellulitis / orbital apex syndrome spreading from sinuses; requires urgent imaging and IV therapy.
Vasoconstrictor-associated arterial spasm (e.g., epinephrine mixtures) has been reported in retinal ischemic events after ENT procedures.
Systemic hypotension/hemodilution during anesthesia predisposes to PION.
Seredyka-Burduk M, et al. Ophthalmic complications of endoscopic sinus surgery—review. Adv Clin Exp Med. [Open-access review summarizing orbital hemorrhage, optic nerve and EOM injuries, orbital emphysema, infection]. 2025.
Maharshak I, Hoang JK, Bhatti MT. Complications of vision loss and ophthalmoplegia during endoscopic sinus surgery. Clin Ophthalmol. 2013;7:573–580. doi:10.2147/OPTH.S40061.
Chowdhary S, et al. Central retinal artery occlusion after naso-sinus surgery—case report and discussion. PMC. 2020.
Rao GN, Rout K, Pal A. Central retinal artery occlusion and third cranial nerve palsy following nasal septoplasty. Case Rep Ophthalmol. 2012;3:321–326. doi:10.1159/000343700
Wang MY, et al. Posterior ischemic optic neuropathy: perioperative risk factors—hypotension, anemia, hemodilution. PMC. 2020.
EyeWiki (AAO). Orbital compartment syndrome—definition, pathophysiology, and urgency. 2025 update.
Roth S. Update on perioperative ischemic optic neuropathy—overview of risk and mechanisms. PMC. 2018.
Demirayak B, et al. Medial rectus muscle injuries after FESS—two cases, mechanism and management. Turk J Ophthalmol. 2015.
Kanwat J, et al. Periorbital emphysema following FESS—sight-threatening potential. PMC. 2024.
