Unexpected amaurosis occurring after peribulbar anesthesia: Exploring the causes in two cases

Area of Science:

• Ophthalmology
• Anesthesiology

Background:

• Peribulbar anesthesia (PB) is a widely used ophthalmic regional anesthesia technique.
• It is generally considered safer than retrobulbar anesthesia (RB) due to a lower risk of globe perforation and retrobulbar hemorrhage.
• Transient amaurosis (vision loss) is an uncommon complication of ophthalmic anesthesia.

Purpose of the Study:

• To report two cases of transient amaurosis following peribulbar anesthesia.
• To discuss potential mechanisms and implications of this rare complication.

Main Methods:

• Two patients undergoing cataract surgery received peribulbar anesthesia.
• Anesthetic consisted of ropivacaine 1% with clonidine adjuvant.
• A second injection was administered due to incomplete akinesia.

Main Results:

• Both patients experienced temporary vision loss (amaurosis) within 30 minutes of PB.
• Ophthalmic examinations, including IOP, anterior segment, and fundus, were normal.
• Visual acuity recovered within 1 day in the first patient.

Conclusions:

• Transient amaurosis can occur after peribulbar anesthesia, even when considered safer than RB.
• Anesthetic spread into the retrobulbar space, particularly after a second injection, may explain these events.
• Careful technique and awareness of potential complications are essential.