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Longstanding diplopia after ethmoidal artery ligation for epistaxis

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

In the rare case of intractable, posterior, non-sphenopalatine artery epistaxis, ligation of ethmoidal arteries using an external approach like a Lynch-type incision is required. Orbital complications, especially extra-ocular motility disorders with diplopia, are known, but in the literature rarely described. Our aim was to analyse the complication type, rate, and outcome of ethmoidal artery ligation for epistaxis.

Materials and methods

Data between 2012 and 2017 of patients treated with ethmoidal artery ligation were analysed retrospectively and through a telephone interview using a non-standardized questionnaire.

Results

Data of 18 patients (m/f = 3/15) aged 53–83 years were reviewed. Epistaxis recurred in only one patient after 1 month. Five patients (28%) suffered from diplopia shortly after surgery. Motility analysis revealed full recovery with free motility in four out of five reported cases after 4–8 months, one patient still reports intermittent mild diplopia more than 1 year postoperatively.

Conclusion

In patients with intractable, non-sphenopalatine artery epistaxis, anterior ethmoidal artery ligation was highly effective. Diplopia, however, occurred in one-third of our patient group. Information about motility restriction with longer standing diplopia are mandatory when consenting patients for ligation of ethmoidal arteries. Special care needs to be taken during dissection in the region of the trochlea and superior oblique muscle.

Level of evidence: Case Series, level 4

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Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, University of Zurich and University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

    S. Bischoff, D. Holzmann & M. B. Soyka

  2. Department of Ophthalmology, University of Zurich and University Hospital Zurich, Zurich, Switzerland

    C. Gerth-Kahlert

Authors
  1. S. Bischoff
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  2. C. Gerth-Kahlert
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  3. D. Holzmann
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  4. M. B. Soyka
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Corresponding author

Correspondence to M. B. Soyka.

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There are no financial conflicts of interest to disclose.

Ethical approval

Patients who were interviewed by telephone gave oral consent to participate in the study; for the retrospective data collection, consent was waived by the ethical committee.

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This research involves human participants.

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Bischoff, S., Gerth-Kahlert, C., Holzmann, D. et al. Longstanding diplopia after ethmoidal artery ligation for epistaxis. Eur Arch Otorhinolaryngol 277, 161–167 (2020). https://doi.org/10.1007/s00405-019-05686-0

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  • DOI: https://doi.org/10.1007/s00405-019-05686-0

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