Postoperative anisocoria in a patient undergoing endoscopic sinus surgery.
OBJECTIVE
Anisocoria after sinus surgery can be related to serious complications such as intraorbital hematoma or increased intracranial pressure secondary to an expanding hematoma.


METHODS
A 51-year-old man underwent endoscopic surgery of sinuses, and developed anisocoria; likely a result of the local spread of cocaine used to provide local anesthesia and vasoconstriction. The localized effect of this anesthetic agent produced a typical picture of nasociliary ganglion block that subsided in a few hours. In the results, the nasociliary nerve block was noticed on recovery from anesthesia with no other neurologic deficit. Ophthalmologic examination demonstrated a short-lasting anisocoria with loss of accommodation and sensory block over the tip of the nose.


CONCLUSIONS
The central spread of the local anesthetics should be considered as a differential diagnosis of unexplained anisocoria, especially when it is associated with loss of corneal reflex.
Stewart
D
D
Department of Anesthesiology, State University of New York at Buffalo, USA.
Simpson
G T
GT
Nader
N D
ND
D000779:Anesthetics, Local / Q000009:adverse effects*; D015875:Anisocoria / Q000139:chemically induced / Q000175:diagnosis*; D003042:Cocaine / Q000009:adverse effects*; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis*; D012852:Sinusitis / Q000601:surgery; D014057:Tomography, X-Ray Computed
D000779:Anesthetics, Local; D003042:Cocaine