Anaesthesia for glaucoma surgery

Abstract

Glaucomatous eyes are at heightened risk of optic nerve damage from local anaesthesia, and this may cause ‘wipe-out’ of vision. Most glaucoma surgery is done on the anterior part of the globe, and can be performed using any of the standard anaesthesia techniques. However, many surgeons prefer to avoid putting any LA near to the optic nerve, and simply anaesthetise the surgical area. Options include sub-conjunctival, sub-Tenon’s, or topical anaesthesia. Glaucoma patients may, of course, have surgery for other reasons. The anaesthesiologist needs to be familiar with the systemic side-effects and interactions of glaucoma medications. Acute rise in intra-ocular pressure may occur in predisposed eyes, and this can be sight-threatening. Acute angle closure glaucoma is discussed, along with a 3-step method to identify patients at risk. Patients who have recently had an intra-ocular gas bubble (with vitrectomy surgery) are at risk of blindness if they have a general anaesthesia with nitrous oxide, in the weeks before the bubble has dissolved.