Retrobulbar anesthesia and retinal vascular obstruction

The cases of three patients who developed combined central retinal artery/vein obstruction secondary to retrobulbar anesthesia are presented. In one case the obstruction was presumably present immediately after surgery, while in the other two it was observed to evolve over a period of several days. A dilated optic nerve sheath was demonstrated by contact B-scan ultrasonography in two cases and by computerized tomography in the third case, suggesting intravaginal sheath hemorrhage as a common underlying pathophysiologic process. Partial return of vision was evident in the latter case following orbitotomy with optic nerve sheath decompression.