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.