Bupivacaine Retinal vascular occlusion after retrobulbar injection in an elderly patient: case report

A retrobulbar injection of 0.75% bupivacaine was administered with a rounded, reusable 23-gauge needle prior to phacoemulsification and posterior chamber lens implantation in the right eye of a 70-year-old man . The patient had a history of lung carcinoma and testicular lymphosarcoma. He had not taken anti platelet agents preoperatively ,

No abnormalities were noted during surgery but 48 hours later the patient had no light perception in his right eye , Intraocular pressure was 12mm Hg and the pupil was amaurotic . Funduscopy revealed central retinal artery occlusion and subhyaloid haemorrhage : the optic disc was pale , A widening of the optic nerve was noted during contact B­scan ultrasonography and dilation of the optic nerve sheath was confirmed by CT scan, Six months later, the patient remained blind in his right eye.

In this case , catastrophic cen tral retinal artery occlusion and optic nerve injury after retrobulbar injection resulted from optic nerve sheath haemorrhage or injection of bupivacaine into the optic nerve , Hersch M, Baer G, D,eckert P Lambert HM Shore JW OptiC nerve enlargement and central rellnal-artery occlUSion secondary to retrobulbar anaesthesia Annals of Ophthalmotogy 21 195-197 May 1989 ,"