Orbital hemorrhage during rhinoplasty.

The most common complication of rhinoplasty is perioperative and postoperative hemorrhage. We present two patients who experienced intraoperative orbital hemorrhage during rhinoplasty. Patients with a history of previous nasal trauma, because of scarring/altered anatomy, may be more prone to this serious complication. A precise and well-placed osteotomy must be done to avoid aberrant anatomy and complications. The proposed mechanism for orbital hemorrhage is shearing or tearing of fibrovascular scar tissue involving the angular vessels during the surgical dissection. Prompt recognition and management of an orbital hemorrhage during or following rhinoplasty is necessary to prevent possible ocular injury and loss of vision. A management algorithm for orbital hemorrhage is presented along with a discussion of surgical techniques to prevent this complication. Surgeons performing rhinoplasty should be cognizant of this type of intraoperative complication along with its medical and surgical management.