{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T11:43:06Z","timestamp":1784115786032,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T00:00:00Z","timestamp":1747008000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Although considered a safe procedure, functional endoscopic sinus surgery (FESS) can cause various significant ophthalmic complications, i.e., serious extraocular muscle (EOM) damage. The aim of this study is to review the surgical management outcomes of patients with mechanical strabismus and diplopia as a complication of FESS, who referred to ophthalmological department in Norbert Barlicki University Teaching Hospital No. 1 over the 5-year period from 2018 to 2023. Methods: The records of seven consecutive patients with diplopia following endoscopic sinus surgery were retrospectively reviewed. Demographics, ophthalmological and orthoptic examination, the results of orbital imaging, type of FESS, type of strabismic surgery, and the timing of the first intervention were analysed. Results: The time from FESS to referral for strabismic intervention varied from one day to two months. Two patients, who were operated upon immediately after the FESS procedure, underwent direct reunion of the proximal and distal parts of the ruptured medial rectus muscle. One patient required maxillofacial intervention in order to improve prominent enophthalmos. The remaining five demonstrated severe adhesion formation around at least one of the EOMs and orbital walls. Only patients who were operated upon within a short period after complicated FESS achieved orthotropia and lack of diplopia in the primary position with a single surgery. Conclusions: Early recognition of the orbital complications subsequent to FESS and prompt referral are essential for achieving a satisfactory surgical result. Appropriate treatment should be based on the mechanism, location, type, and severity of muscle damage.<\/jats:p>","DOI":"10.3390\/jcm14103360","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T09:13:38Z","timestamp":1747041218000},"page":"3360","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Management of Mechanical Strabismus After Complicated Functional Endoscopic Sinus Surgery (FESS)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7924-503X","authenticated-orcid":false,"given":"Katarzyna","family":"Peli\u0144ska","sequence":"first","affiliation":[{"name":"Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, Narutowicza Street 96, 90-141 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justyna","family":"Simiera","sequence":"additional","affiliation":[{"name":"Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, Narutowicza Street 96, 90-141 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Loba","sequence":"additional","affiliation":[{"name":"Department of Binocular Vision Pathophysiology and Strabismus, Medical University of Lodz, Narutowicza Street 96, 90-141 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1002\/lary.24401","article-title":"Complications of primary and revision functional endoscopic sinus surgery for chronic rhinosinusitis","volume":"124","author":"Krings","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"70","DOI":"10.5001\/omj.2009.18","article-title":"Functional endoscopic sinus surgery: Indications and complications in the ophthalmic field","volume":"24","author":"Wali","year":"2009","journal-title":"Oman Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5005\/jp-journals-10003-1182","article-title":"Anesthetic Considerations in Functional Endoscopic Sinus Surgery","volume":"7","author":"Ubale","year":"2015","journal-title":"Int. J. Otorhinolaryngol. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1002\/lary.21446","article-title":"Complications in endoscopic sinus surgery for chronic rhinosinusitis: A 25-year experience","volume":"121","author":"Stankiewicz","year":"2011","journal-title":"Laryngoscope"},{"key":"ref_6","first-page":"141","article-title":"Complications in endonasal sinus surgery: A 5-year retrospective study of 2,596 patients","volume":"270","author":"Siedek","year":"2013","journal-title":"Eur. Arch. Oto-Rhino-Laryngol. Off. J. Eur. Fed. Oto-Rhino-Laryngol. Soc. (EUFOS) Affil. Ger. Soc. Oto-Rhino-Laryngol. Head Neck Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1136\/bjo.85.5.598","article-title":"Major orbital complications of endoscopic sinus surgery","volume":"85","author":"Rene","year":"2001","journal-title":"Br. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.4193\/RHINOL\/19.004","article-title":"Modeling Microdebrider-Mediated Ophthalmic Damage: A Word of Caution in Endoscopic Sinus Surgery","volume":"2","author":"Worden","year":"2019","journal-title":"Rhinol. Online"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/S0039-6257(03)00055-9","article-title":"Ophthalmic complications of endoscopic sinus surgery","volume":"48","author":"Bhatti","year":"2003","journal-title":"Surv. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.bjorl.2016.04.006","article-title":"Ophthalmic complications of endoscopic sinus surgery","volume":"83","author":"Burduk","year":"2017","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_11","first-page":"001","article-title":"Presumed Orbital Infarction Syndrome after Functional Endoscopic Sinus Surgery (FESS)","volume":"13","author":"Kassem","year":"2019","journal-title":"Biomed. J. Sci. Tech. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.otc.2017.01.009","article-title":"Advances in Microdebrider Technology: Improving Functionality and Expanding Utility","volume":"50","author":"Tang","year":"2017","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.crad.2005.03.005","article-title":"Orbital complications of functional endoscopic sinus surgery: MR and CT findings","volume":"60","author":"Bhatti","year":"2005","journal-title":"Clin. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.otc.2010.04.007","article-title":"Prevention and management of medial rectus injury","volume":"43","author":"Bleier","year":"2010","journal-title":"Otolaryngol. Clin. N. Am."},{"key":"ref_15","first-page":"488","article-title":"Strabismic complications following endoscopic sinus surgery: Diagnosis and surgical management","volume":"8","author":"Thacker","year":"2004","journal-title":"J. AAPOS Off. Publ. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_16","first-page":"CS94","article-title":"The use of modern imaging techniques in the diagnosis and treatment planning of patients with orbital floor fractures","volume":"17","author":"Loba","year":"2011","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4274\/tjo.01328","article-title":"Medial Rectus Muscle Injuries after Functional Endoscopic Sinus Surgery","volume":"45","author":"Demirayak","year":"2015","journal-title":"Turk. J. Ophthalmol."},{"key":"ref_18","first-page":"250","article-title":"Treatment of subtotal medial rectus myectomy complicating functional endoscopic sinus surgery","volume":"4","author":"Trotter","year":"2000","journal-title":"J. AAPOS Off. Publ. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.5301\/ejo.5000689","article-title":"Tendon elongation with bovine pericardium (Tutopatch\u00ae) when conventional strabismus surgery is not possible","volume":"26","author":"Krijnen","year":"2016","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3928\/0191-3913-19910301-11","article-title":"Superior oblique silicone expander for Brown syndrome and superior oblique overaction","volume":"28","author":"Wright","year":"1991","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_21","first-page":"20","article-title":"Vertical muscle transposition augmented with lateral fixation","volume":"1","author":"Foster","year":"1997","journal-title":"J. AAPOS Off. Publ. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_22","first-page":"287","article-title":"A new application of modified Nishida muscle transposition procedure for medial rectus muscle transection following endoscopic sinus surgery without tenotomy or splitting muscles","volume":"23","author":"Kong","year":"2019","journal-title":"J. AAPOS Off. Publ. Am. Assoc. Pediatr. Ophthalmol. Strabismus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3360\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:31:15Z","timestamp":1760031075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,12]]},"references-count":22,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103360"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103360","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,12]]}}}