Visual acuity after retrobulbar anesthesia

Patients often say that they can see the surgical instruments with the operated eye during intraocular surgery. We examined 26 consecutive patients for visual acuity, ocular motility, and pupillary response before, during, and after retrobulbar anesthesia for cataract extraction. Twenty minutes after the anesthetic was injected, 19% of these patients had visual acuities better than 6/200, and 73% of patients described the movements of the instruments during surgery. Two patients (8%) recognized details on the ceiling after insertion of the intraocular lens. An afferent pupillary defect was found in 31% of patients. Although retrobulbar anesthesia results in a marked decrease in ocular motility and visual acuity, total akinesia and blindness do not occur. An incidental result of retrobulbar anesthesia may be a transient afferent pupillary defect.