Recognition and management of Orbital Bleeding

Obviously the eyes need to be exposed during the case.  Often what is going on intranasally gives little indication of the problem.  The eye rapidly grows proptotic and tense.  Immediate cantholysis and canthotomy is necessary to allow the globe to release anteriorly.  The next move I made was to decompress the orbit a bit intranassaly.  I also made an immediate Lynch incision and bipolared the offending artery.  Some Arista was also used and the final ethmoid packing was fairly loose.

Anterior Ethmoid Artery Hemorrage

It is not unusual for recurrent polyps or papillomatous sinus disease to lead to dehissance of the Lamina Papyrecea.  The Anterior Ethmoid Artery is in close proximitry to this region and injury is possible.  I have probably done as many sinus surgeries as anyone alive and kind of felt that my super human skills left me immune to this complication, until now.  The intranasal surgery showed little sign of any problem, but the exposed eye become immediately proptotic and tense.