Consequence of perforation during peribulbar anesthesia in an only eye.
A patient with a blind fellow eye had cataract surgery in the right eye; anesthesia comprised an intraocular injection of lidocaine and bupivacaine. Forty-eight hours after surgery, visual acuity in the right eye was light perception (LP). Three days later, fundus examination showed inferotemporal hemorrhage, retinal whitening consistent with needle tracking, and a diffusely pale optic disc in the operated eye. Computed tomography showed an intact optic nerve in both eyes and high-density vitreal lesions in the right eye. Laser photocoagulation was applied to the retinal break. We believe that a jet stream of anesthetic agent may have transiently increased intraocular volume enough to occlude the central retinal artery. Although the retina remained attached, visual acuity failed to improve beyond LP.
Lake
Damian
D
St. George's Hospital, London, United Kingdom. lakedamian@hotmail.com
Mearza
Ali
A
Ionides
Alex
A
D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001766:Blindness / Q000209:etiology*; D002045:Bupivacaine / Q000008:administration & dosage; D015807:Eye Injuries, Penetrating / Q000209:etiology*; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000008:administration & dosage; D016602:Needlestick Injuries / Q000209:etiology*; D018918:Phacoemulsification; D012160:Retina / Q000293:injuries*; D012166:Retinal Hemorrhage / Q000209:etiology; D012167:Retinal Perforations / Q000209:etiology*
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine