[Acute ischemia of the optic nerve after retrobulbar injection]

The authors present a case of acute amaurosis following a retrobulbar injection of anaesthetic. The patient was a mononephric subject in hemodialytic treatment receiving, therefore, a daily therapy by heparin. The ophthalmoscopic feature reveals a pale optic disk oedema, normal arteries and tortuous veins; the fluorescein angiography confirms the papillary oedema and the normal arterial fillings. The echographic picture shows an hematic collection through the nerve sheath. The authors analyze the main pathogenic hypothesis of the amaurosis which should be ascribed to an acute ischemia of the disk caused by the hematoma formed through the nerve sheath. The role of the general conditions of the patient, mononephric in hemodialytic treatment, is emphasized as a possible risk factor even for a retrobulbar injection.