Year : 2018  |  Volume : 26  |  Issue : 2  |  Page : 133-136

An uncommon case of intraoperative retrobulbar hemorrhage following sub-tenon’s anesthesia: A case report

Department of Ophthalmology, University College Hospital, Ibadan, Ibadan, Oyo State, Nigeria

Correspondence Address:
Dr. Patrick O Idam
Department of Ophthalmology, University College Hospital, Ibadan, PMB 5116 Ibadan, Oyo State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njo.njo_18_18

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A 51-year-old woman presented to the eye clinic with complaint of poor vision OS. She had a visual acuity of 6/6−2 OD and Hand Motion OS. Pupillary examination revealed a round active pupil OD and a relative afferent pupillary defect OS, open angles on gonioscopy OU, cup/disc ratio of 0.5 OD and 1.0 OS and intraocular pressure of 19-mmHg OD and 39-mmHg OS. A diagnosis of bilateral primary open angle glaucoma was made. She was subsequently booked for bilateral trabeculectomy following failed medical therapy. Preoperatively, she had O’Brien facial block and sub-Tenon’s anesthesia prior to commencement of right trabeculectomy surgery. She coughed persistently and strained intensely throughout surgery. She was subsequently noted to have persistent shallowing of the anterior chamber toward the end of surgery with associated proptosis, chemosis, and subconjunctival hemorrhage. A diagnosis of intraoperative retrobulbar hemorrhage (RBH) was made, and she had prompt lateral canthotomy and 500-mg stat dose of tab acetazolamide. Following reduction of the proptosis, the eye was padded and she was placed on tab acetazolamide 250 mg 8 hourly, tab chymotrypsin/trypsin 500 mg 8 hourly, tab paracetamol 1 g 8 hourly, and tab prednisolone 60 mg daily. She was subsequently discharged on the 4th postoperative day following resolution of clinical features and improvement in bleb morphology. Sub-Tenon’s anesthesia rarely causes intraoperative RBH. Prompt recognition and urgent surgical intervention is key to successful management of this condition.

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