Vision loss, third and fourth nerve palsy and non‐responsive midriasis after contralateral retrobulbar anaesthesia

Abstract

AbstractPurpose: The purpose of this communication is to report a case of vision loss, third, and fourth nerve palsy and midriasis after contralateral retrobulbar anaesthesia. Although contralateral vision loss has been reported after locoregional block, very little evidence has been found about contralateral extraocular movement palsy and midriasis. Mechanism is not well known, though it is believed to be a consequence of the accidental subdural/subarachnoid anaesthetic injection.Methods: A case which took place at our hospital was selected. A retrobulbar block was performed by the service of anesthesiology in an 80‐year‐old patient prior to cataract surgery on the right eye. The block consisted of a 5 ml injection of 0.5% levobupicain and 2% lidocain (1:1) in his right eye under monitorization and sterile conditions. 10 min after the injection the patient presented bradycardia, hypotension and decreased consciousness. He was administered 0.6 mg atropine, 3 ephedrine bolus and 8 migr noradrenaline and his constants came back to normality. He was kept in observation in the recovery room. After consciousness recovery he claimed vision loss in the fellow eye.Results: At the exploration we found complete vision loss with no light perception, ptosis, third and fourth nerve palsy and dilated and non‐responsive pupil in the left eye. Funduscopy was unremarkable. He was kept in observation and 45 min later he was reexplored: ptosis, extraocular movements and pupil size improved; 2 h later exploration was completely normal.Conclusions: To conclude, we wanted to remember some of the possible complications of retrobulbar block and the importance of its conscious selection. Above all, we wanted to highlight this infrequent reaction on the fellow eye about which we have found very little evidence.