Strabismus following Endonasal sinus surgery: a 10-year retrospective analysis of clinical profile and outcomes.

PURPOSE: To evaluate the clinical characteristics, motility deficits, strabismus patterns, and management outcomes in patients developing strabismus following Endonasal Sinus Surgery (ESS).

METHODS

This retrospective study was conducted over 10 years (2015-2025) at a tertiary eye care center. Demographic details, type and severity of ocular motility restriction, strabismus pattern, imaging findings, and management (surgical, prisms, or observation) were documented. Outcomes were assessed in terms of ocular alignment and symptomatic improvement.

RESULT: Ten patients were identified, with male-to-female ratio of 4:1 (8:2) and mean age of 40.3 years (range 24-62 years). Ocular motility limitation was present in (n = 9; 90%) patients. Limitation of adduction was most commonly present involving the medial rectus n = 7; 70%. Large angle exotropia was the predominant pattern, with a deviation range of 30-75 prism diopters (PD). Management varied: five patients (50%) underwent strabismus surgery, showing improvement but residual deviation in most; one patient (10%) was managed with prisms, achieving partial symptomatic relief; and three patients (30%) were observed conservatively. One patient (10%) was lost to follow up and did not receive further management. Despite intervention, restrictive cases showed incomplete recovery.

CONCLUSION

Strabismus is a rare but a significant (functional) complication following Endonasal sinus surgery, typically presenting as restrictive large-angle exotropia. Surgical correction and prisms provide functional improvement, though complete resolution is uncommon considering the extent of the injury. Early recognition and multidisciplinary management are crucial to optimize outcomes.