External ophthalmoplegia after total intravenous anaesthesia

Eye-opening and eye movements were assessed in 110 awake and cooperative ASA class 1 and 2 patients after elective ENT surgery with total intravenous anaesthesia using propofol, fentanyl and atracurium. Following tracheal extubation and after regaining consciousness 21 patients showed a complete transient bilateral inability to open their eyes combined with a total gaze paresis, while another 30 patients showed an impairment of eye-opening and/or eye movements to a lesser extent. In all patients affected symmetrical recovery of both impaired eye-opening and eye movements occurred during the following 20 min. The occurrence of ophthalmological symptoms was not related to the duration of anaesthesia or the propofol infusion rate. Thus a complex ophthalmological phenomenon occurred after total intravenous anaesthesia in approximately 50% of awake and cooperative patients. The aetiology of this phenomenon and the implications for the understanding of the mechanisms of general anaesthesia remain to be determined.