[Ocular side effects of added sympathomimetics in local anesthetics]

In facial dermatosurgery, the addition of sympathomimetics to local anesthetics produces a desirable topical effect as they provide an almost bloodless operation field due to temporary vasoconstriction. In an 87-year-old woman, who had lost her left sight owing to a meningoma, we removed a basal-cell carcinoma from the right side of her nose. The local anesthetic applied contained noradrenaline at a concentration of 1:50,000. After the operation, the patient complained of a headache and a transitory loss of sight. We suppose that noradrenaline reached the arteria centralis retinae via arterial periorbital anastomoses, thus causing a vasoconstriction of this artery. As far as dermatosurgery of the middle and upper face is concerned, patients with severe vision disorders should be considered as a risk group; in local anesthesia of those patients an addition of sympathomimetics should be avoided.