Endoscopic Surgery Helps Preserve Vision After Complex Orbital Injury: Dr. Harnarayan Singh

Recalling this case, Dr Harnarayan Singh, Director and HOD, Neurosurgery, said, “In this case, the biggest challenge was not simply removing the foreign body. It was removing it without causing further damage to an eye that had already suffered a major injury.” Dr Harnarayan Singh led the neurosurgery and skull base surgery team. Actually, the boy had already undergone several procedures previously, but the problem was not completely resolved. Pain was consistent, particularly when moving the affected eye.

The metal piece was positioned on the inner side of the optic nerve. One possible way to treat was a craniotomy. In this process, a portion of the skull is removed, and the surgeon enters the orbit from above. Surgeons had to operate through the skull, with the possibility of a visible scar and a greater risk of injury to the optic nerve.

After analysing the condition, the team chose another way. They decided to approach the lodged metal piece through the nose using an endoscopic endonasal technique. This resulted a better cosmetic outcome and, more importantly, provided a safer path towards the fragment because of its position relative to the optic nerve.

Dr Kunal Nigam, Senior Consultant and HOD, ENT explained, “The fragment was located on the inner side of the optic nerve. Approaching it through the nose gave us a more favourable route. Our priority was to remove the metal while preserving remaining vision.”

Endoscopic endonasal surgery for such cases is not commonly performed. Anatomy is complex and the working space is extremely limited. Doctors has to work around critical structures while maintaining precise control of the instruments. Due to the difficulty of the case, the patient had been refused surgery at several hospitals. Surgeons were reluctant to take on a procedure where even a small error could potentially affect the already compromised vision.

Finally, the neurosurgery and skull base surgery team led by Dr Harnarayan Singh and Dr Kunal Nigam decided to take up the case.

The surgery lasted around five hours. Using the endoscopic route through the nose, the team carefully reached the deep orbital region and removed the one-centimetre-long metal fragment.

Dr. Harnarayan Singh said, “The eye had already lost a significant amount of vision because of the original injury. So, every step during the surgery had to be carefully planned. The case highlights how difficult orbital injuries can become when a foreign body remains lodged close to the optic nerve.”

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