Blindness following retrobulbar anesthesia for astigmatic keratotomy

Retrobulbar anesthesia has become the most common form of anesthesia used in ophthalmic surgery. Acute blindness is a rare but known complication of retrobulbar anesthesia given for intraocular surgery. I report a case of acute, permanent blindness caused by direct trauma to the optic nerve when retrobulbar anesthesia was used for an astigmatism correction procedure. Complications, sometimes probably too incidental or insignificant to be noticed, probably occur far more frequently than a review of the literature would indicate. Using dull shorter needles, proper eye positioning, and injection technique will minimize risk of injury to the optic nerve. Another alternative under review is the use of peribulbar anesthesia. Perhaps the best way to prevent a complication from a retrobulbar injection, however, is to carefully and judiciously consider whether any injection at all is needed.