Endoscopic Sinus Surgery

To the Editor.—I wish to describe to your readers the phenomenon that occurred on two occasions while performing endoscopic ethmoidectomy and middle meatus maxillary sinus antrostomy. I have been performing endoscopy sinus surgery since 1988 and have attended three prestigious courses in the United States. I have followed the guidelines recommended by the learned authorities on the subject. I have used 0.5% or 1% phenylephrine (Neo-Synephrine) topical packs intermittently during surgery. Preoperatively, the middle turbinates and the lateral wall of the middle meatus are infiltrated with a small amount of 1% lidocaine (Xylocaine) and 1:100 000 epinephrine (Adrenalin). On both occasions, about 1 hour into the surgery, I noticed marked dilatation of the right pupil. The left pupil was of normal size under general anesthesia. The eye was carefully checked, there was no periorbital ecchymosis or increased pressure in the right orbit. I was sure that I had not