Dilated pupils and loss of accommodation following diode panretinal photocoagulation with sub-tenon local anaesthetic in four cases.
OBJECTIVE
To describe pupillary abnormalities associated with diode laser photocoagulation with subTenon's local anaesthetic.


METHODS
We describe four cases of tonic pupils following diabetic panretinal photocoagulation with subTenon's local anaesthetic.


RESULTS
Six pupils of four patients became dilated and sustained loss of accommodation with denervation hypersensitivity with 0.1% pilocarpine after undergoing panretinal photocoagulation with a subTenon's local anaesthetic. The numbers of burns were not excessive and in one patient it even occurred after only 1200 laser burns.


CONCLUSIONS
Diode laser causes histological changes deeper in the retina and the choroid than in Argon laser. Intense diode laser burns may cause damage to the short ciliary nerves traversing the choroid. In the unanaesthetised patient, pain arises when the laser burn hits these nerves and so may protect the eye from excess damage to the nerves. When the eye is anaesthetised with a subTenon's, local anaesthetic damage to the choroidal nerves may occur without the laser operator being aware that the burns are too intense.
Institute of Ophthalmology, London EC1V 9EL, UK. jigs37@hotmail.com
J I
JI
Patel
L
L
Jenkins
L
L
Benjamin
S
S
Webber
D000328:Adult; D000772:Anesthesia, Local / Q000009:adverse effects*; D003930:Diabetic Retinopathy / Q000601:surgery*; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015845:Tonic Pupil / Q000209:etiology*