Loss of vision post dacryocystectomy surgery

Dacryocystectomy (DCT) is a relatively minor oculoplastic procedure with specific indications and remains a common lacrimal surgery in the Indian subcontinent. A 66-year-old hypertensive female with a mature cataract complained of painful vision loss on postoperative day 1 of DCT surgery. Visual acuity of nil light perception in the right eye with proptosis and limited extraocular motility was noted. Despite an urgent lateral canthotomy with cantholysis and intravenous steroid injection, there was no improvement in vision. Computed tomography of the orbits revealed an orbital hematoma on the right side with proptosis and optic nerve straightening. Orbital injury following a breach of the periorbita was deemed the probable cause. Vision loss due to orbital compartment syndrome is an uncommon but devastating complication following DCT surgery. Although DCT is considered to be a minor procedure, improper surgical technique and dissection may have catastrophic consequences.