Amaurosis, ophthalmoplegia, ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia.
BACKGROUND
Ophthalmic complications following inferior alveolar nerve anaesthesia are rare. They include transient blindness (amaurosis), ophthalmoplegia, ptosis, mydriasis and diplopia. These events may occur following the intravascular administration of anaesthetic solution and are distressing to both patient and operator alike.


METHODS
We report the unusual case of a young patient who experienced amaurosis, total ophthalmoplegia, complete upper eyelid ptosis, mydriasis and periorbital blanching following inferior alveolar nerve anaesthesia. Similar but less profound signs were observed in the same patient on a subsequent occasion. This was following general anaesthesia, during which she had received local anaesthetic prior to mandibular wisdom tooth removal.


CONCLUSIONS
Ophthalmic complications following inferior alveolar nerve anaesthesia are rare but distressing events. In particular, amaurosis is an extremely rare event and usually heralds a more sinister pathology such as stroke. Clinicians should be aware of these complications to minimise anxiety and reassure their patients appropriately.
Williams
J V
JV
Department of Oral and Maxillofacial Surgery, Frenchay Hospital, Bristol, UK. j.v.williams@doctors.org.uk
Williams
L R
LR
Colbert
S D
SD
Revington
P J
PJ
D000328:Adult; D020757:Amaurosis Fugax / Q000139:chemically induced*; D000766:Anesthesia, Dental / Q000009:adverse effects*; D000768:Anesthesia, General; D000772:Anesthesia, Local / Q000009:adverse effects*; D001763:Blepharoptosis / Q000139:chemically induced*; D004837:Epinephrine / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000139:chemically induced*; D008012:Lidocaine / Q000009:adverse effects*; D008340:Mandibular Nerve / Q000187:drug effects*; D008964:Molar, Third / Q000601:surgery*; D015878:Mydriasis / Q000139:chemically induced*; D009886:Ophthalmoplegia / Q000139:chemically induced*; D009915:Orbit / Q000098:blood supply*; D012086:Reoperation; D014081:Tooth Extraction
D008012:Lidocaine; D004837:Epinephrine