Ocular perforation during retrobulbar and peribulbar injections

BACKGROUND AND OBJECTIVE: To determine the ocular perforations during retrobulbar and peribulbar injections. PATIENTS AND METHODS: Twenty-five ocular perforations between 1976 and 1993 occurred after 13 retrobulbar and 12 peribulbar injections. Eighteen patients (72%) were women. Eighteen eyes were myopic (72%). Risk factors included high myopia in 11 cases (44%), use of Atkinson gaze in 21 cases (84%) and a sharp injection needle. RESULTS: Deep position of the posterior pole was common. Perforation signs comprised vitreous hemorrhage in 25 eyes (100%), subretinal hemorrhage in 19 eyes (76%), retinal breaks along the inferior vascular arcade in 19 eyes (76%), and retinal detachment in 14 eyes (56%). Proliferative vitreoretinopathy developed in 11 eyes (44%). CONCLUSION: Retinal detachment strongly correlated to poor visual outcome.     

Retrobulbar hemorrhage after 12,500 retrobulbar blocks

To determine the incidence of hemorrhage after retrobulbar nerve block, 12,500 consecutive cases were reviewed. Fifty-five retrobulbar hemorrhages occurred after retrobulbar injection, a prevalence of 1 in 227 (0.44%). This compares favorably with the quoted prevalence of 1%-3% in the literature. Acquired vascular disease was a significant risk factor (P < 0.017). Surgery was postponed in 41 (75%) of the cases in which a hemorrhage developed. Although retrobulbar hemorrhage is considered a serious complication of retrobulbar anesthesia, the eventual visual outcome after surgery in these patients was not significantly different from the control group.     

Previously undiagnosed lymphoma presenting as recurrent dacryocystitis

Lymphoma occurring in the lacrimal sac is uncommon and usually occurs in patients with known systemic disease. We report the case of an 82-year-old woman who presented with recurrent right dacryocystitis and a mass in the left lower eyelid. The results of the biopsy of the eyelid and fine-needle aspiration of the swelling arising from the lacrimal fossa demonstrated low-grade B-cell non-Hodgkin's lymphoma. This unusual presentation and the histopathological features are described.     

Response of intraocular pressure to retrobulbar and peribulbar anesthesia

BACKGROUND AND OBJECTIVE: To evaluate the response of intraocular pressure (IOP) to retrobulbar and peribulbar anesthesia. PATIENTS AND METHODS: Patients were prospectively masked and randomized to receive either 4 cc of retrobulbar anesthesia (X = 29) or 6 cc of peribulbar anesthesia (X = 30), each consisting of a 50:50 mixture of 2% xylocaine and 0.75% bupivacaine with 150 units of hyaluronidase. IOPs were measured pre-anesthesia and 1, 2, and 5 minutes post-anesthesia in nonglaucoma patients undergoing cataract extraction and intraocular lens implantation. RESULTS: Mean IOPs in the retrobulbar group as determined with a tonometer were 18.24, 18.66, 19.14, and 17.86 mm Hg pre-anesthesia and 1, 2, and 5 minutes post-anesthesia, respectively. In the peribulbar group, the mean IOPs were 18.53, 21.20, 20.40, and 19.20 mm Hg, respectively. The 1-minute pressures in the two groups were statistically different (P = .023). Within the peribulbar group, the 1- and 2-minute pressures were statistically different from the pre-anesthesia IOP (P = .001 and P = .018, respectively). CONCLUSION: Peribulbar anesthesia, with its higher volume of anesthetic (6 vs 4 cc), results in a higher initial IOP. This difference was slight and short lived, and occurred in the absence of any external ocular compression. This study may have application in avoiding elevation of IOP in select patients undergoing a local procedure.     

Macular hole secondary to retrobulbar needle perforation

An unusual case of cerebral toxoplasmosis leading to a fatal vehicular crash is presented. Massive intracerebral hemorrhage, a rare complication of cerebral toxoplasmosis in persons with acquired immunodeficiency syndrome (AIDS), caused sudden onset of increased intracranial pressure that led to loss of control of the vehicle and an ensuing fatal traffic crash.     

MR of the eye with retrobulbar anesthesia

MR imaging with retrobulbar anesthesia was performed in eight patients with uveal melanoma. Injection of 2 mL prilocain hydrochloride in 2% epinephrin into the eye muscle cone resulted in improved image quality in seven patients, without side effects. Ocular MR imaging can be indicated to clarify indeterminate sonographic findings in cases of extrascleral growth or to exclude optic nerve invasion in patients with tumors located at the posterior pole of the globe.     

Comparison of etidocaine and bupivacaine + lidocaine in retrobulbar anaesthesia

Etidocaine (15 mg/ml) was compared with bupivacaine (5 mg/ml) combined with lidocaine (10 mg/ml) in retrobulbar anaesthesia. One hundred and twelve patients were randomised into two groups. Supplemental anaesthesia was needed in 41% of cases of the etidocaine group and 32% of the bupivacaine-lidocaine group. Akinesia was evaluated by the surgeon both pre- and postoperatively and was found to be good or complete in more than 95% of both groups. Recovery from the motor and sensory block was investigated three times during the first 24 postoperative hours. The motor block of the orbicular muscle disappeared earlier than that of the globe. Akinesia lasted significantly longer in the etidocaine group than in the bupivacaine-lidocaine group: after 14 h 69% vs 100%, respectively, of the eyes showed normal movements. Sensation in the cornea was also regained more rapidly in patients treated with the mixture.     

Brain abscess

Possibilities of utilization of isozymes as markers of the activity of genes in ontogenesis are considered. There are cases of both the synchronous and asynchronous activation of paternal and maternal genes controlling the synthesis of appropriate isozymes. The asynchronous activation is peculiar, mainly, of interspecific hybrids. The organospecific pattern of isozymes in ontogenesis is determined not only by the activity of structural genes controlling their syntheses, but also by numerous genes-modificators active at the translation and posttranslation levels.     

Impaired temporal resolution of vision after acute retrobulbar neuritis

Following retrobulbar neuritis patients need a greater interval between two flashes of light in order to see them as double. The abnormality is large and easily detectable; the values lie well outside the normal 99 per cent tolerance limits. The abnormality sometimes occurs in localized retinal areas but can cover the whole visual field. The abnormality is a persistent one, remaining up to five years after visual acuity has returned to normal. It can occur in the absence of optic atrophy and with normal visual fields. There is also a delay in visual perception following retrobulbar neuritis but when this and double flash discrimination are both measured at the same retinal sites, the areas of abnormality do not correlate for the two tests. This indicates that the two tests monitor different aspects of visual damage. Double flash threshold can be a more sensitive indication of visual damage due to demyelination than conventional clinical tests including critical flicker fusion frequency. It provides an absolute measurement of local damage in the visual field and has advantages over the recording of perceptual delay and of evoked potentials.     

Needle entrance into the maxillary sinus during retrobulbar anesthesia

Three patients are presented to whom an accidental needle entrance into the maxillary sinus occurred during retrobulbar anesthesia. In all cases air was aspirated during the aspiration check at the end of needle advancement, and the patients reported a bitter taste after the injection of a small quantity of anesthetic. After withdrawal and careful reinsertion of the needle, maxillary sinus entrance was avoided and a successful retrobulbar block was achieved. Two of the patients had no history of previous facial trauma or surgery, whereas the third had suffered a recent blowout fracture of the orbital floor. The authors suggest that air aspiration or anesthetic passage into the pharynx during retrobulbar anesthesia should raise the suspicion of maxillary sinus entrance, even in patients without any history of facial trauma or surgery. The early recognition of sinus entrance can prevent retrobulbar block failure and reinjection of a second anesthetic dose.     

Managing periorbital space abscess. Secondary to dentoalveolar abscess

Although orbital space infections are a relatively rare sequela of dentoalveolar infections, such cases have been reported. This case report describes the management of an abscess involving the left eye that originated as a dental abscess.