Subarachnoid injection as a complication of retrobulbar anesthesia

We studied eight cases of apparent subarachnoid injection of local anesthetic through the optic nerve sheath and subsequent spread to the parabrainstem cisterns and the contralateral optic nerve sheath. The patients all experienced bilateral decrease in vision and ophthalmoplegia, and variable degrees of central nervous system symptoms and respiratory depression. The complications occurred with a variety of local anesthetic agents and with sharp disposable needles in six of the eight cases. These cases demonstrated the spectrum of signs and symptoms that may follow optic nerve sheath injection of local anesthetic agents.