Question:
On 10/1, my 41 yo daughter had surgery for removal of a moderate-sized nasal polyp and sinus surgery. For months prior to the procedure, she received antibiotic & steroid therapy in an attempt to help with chronically infected & painful frontal sinuses & a blocked passage.
Unfortunately, on the second post-op day, she developed excruciating headache and eye pain on the side of surgery (R). It became so severe that she was told to see the surgeon yesterday, 10/5, when she reported stabbing pain along the right cheek, into her eye & head. The surgeon suctioned her of quite a bit of debris, started her on saline rinses and told her to take two Vicodin q 6 h, and one Aleve at the midway point of the Vicodin doses. Additionally, she is on 30 mg of Prednisone daily x5 days, to decrease tomorrow to 20 mg daily x 5d, then 10 mg daily x5d, then discontinue.
My apprehension about her pain has grown tremendously since googling sinus post-procedural pain & the rare risk of eye or brain issue following this procedure. My daughter had an MRI in addition to the normal CT scan prior to procedure since the surgeon felt he needed to more definitively tell whether or not the lesion in her nose was a polyp vs encephalocele, due to its position. Following surgery, he did state that it definitely was not an encephalocele. Although it is the weekend, my daughter was told to call (the surgeon) if any vision problems at all occurred, which thankfully has not happened.
I would so appreciate any information or tips you may give. I assume it is too early to think about having my daughter see an ENT or other specialist (?) at the Univ. of Miami at Jackson Memorial, a 1-2 hr trip from home. I am not sure how soon she could be seen either, but am afraid of “waiting this out” to see if her vision becomes affected???? Any help would be MOST appreciated.
Can you send any encouraging word?
Answer:
Thanks for your note.
I wish I could answer completely without knowing your daughter and her surgery more personally. However, as you know, complications with the eye and even intra-cranial (brain) complications are possible, but quite rare with nasal and sinus surgery. As a surgeon, I would be quite concerned should my patient have significant pain after surgery (it is rare as well). However, it sounds like the surgeon checked to see that there was no complication at the visit. Should there have been a complication with the eye, one would be most concerned about visual loss, double vision, getting black and blue around the eye or loss of vision. It sounds like she has not had any of those issues. Intracranial complications (brain fluid leaks, etc) rarely cause such pain either. One would most likely see a clear fluid discharge- Headache would be possible if there were meningitis- but one would expect other findings as well, such as a stiff neck.
It sounds like she is in good hands (appropriate to have checked to see with MRI as well as CT that this was not an encephalocele) and I would follow up as your daughter’s surgeon suggests.
Should she have questions or concerns, of course we’d be happy to see her up here at the NY Sinus Center. One wonderful sinus specialist closer to you is Donald Lanza- in Tampa. But by your description alone, I do not see anything that makes me feel your daughter’s care has been anything but good or that she needs other urgent intervention.
I hope this helps clear things up.
Robert Pincus MD
NY Sinus Center
Frequently Asked Questions
Common complications from nasal polyp and sinus surgery include pain, bleeding, and infection. More serious but rare complications involve eye issues such as vision changes or double vision, and intracranial problems like brain fluid leaks. Regular follow-up with the surgeon helps monitor and manage any postoperative symptoms.
While some discomfort is expected after sinus surgery, excruciating headache and eye pain are uncommon and warrant close attention. Severe pain may indicate postoperative issues, so patients should consult their surgeon promptly if experiencing intense symptoms or worsening pain.
Emergency care is necessary if the patient develops vision changes, double vision, significant swelling or bruising around the eye, clear fluid discharge from the nose indicating possible brain fluid leak, or signs of meningitis such as stiff neck and fever. These symptoms suggest rare but serious complications requiring immediate attention.
Pain management after sinus surgery often includes prescription painkillers like Vicodin and anti-inflammatory drugs such as Aleve. Additionally, steroids like Prednisone are prescribed to reduce inflammation and help with healing. Dosages and schedules are adjusted based on recovery progress and surgeon recommendations.
Imaging, such as CT scans and MRIs, plays a crucial role before sinus surgery to define the lesion type and plan the procedure safely. Postoperative imaging can help rule out complications like encephalocele or other structural issues. This ensures accurate diagnosis and appropriate surgical intervention.
If concerning symptoms arise post-surgery, such as severe pain or potential vision problems, consulting a specialist like an ENT or sinus surgeon is advisable. However, if the current surgeon is adequately monitoring postoperative progress and there are no urgent signs, waiting for scheduled follow-up may be appropriate.
Signs include visual disturbances (blurred or double vision), black and blue discoloration around the eye, persistent or worsening severe headache, clear nasal discharge indicating CSF leak, and neurological symptoms like stiff neck or fever. These signs require immediate medical evaluation.
