Acute Angle-Closure Glaucoma After General Anesthesia for Bone Grafting

Abstract

Acute angle-closure glaucoma (AACG) is a rare complication of general anesthesia. The coexistence of individual risk factors for postoperative AACG and factors associated with intraocular hypertension are considered to be required for postoperative AACG to develop. We present a case of AACG after general anesthesia for oral bone grafting in a patient with no preoperative eye symptoms. In this case, several factors such as postoperative care in a darkened room, psychological stress, and postoperative hypertension may have precipitated the event in this patient, who may have had preexisting undiagnosed elevated intraocular pressure. The interval between the earliest appearance of symptoms at 9 hours and the ultimate diagnosis was 36 hours. In the postoperative period following general anesthesia, any patient is at risk for AACG. It is important that a postoperative diagnosis of AACG should be considered and a timely consultation with an ophthalmologist be considered if a postoperative patient complains of red eyes, visual disorder, eye pain, headache, and nausea.

Is There a Link Between Abdominal Surgery and Ocular Pressure?

“…Therefore, the author of the study considers very important an ophthalmic examination for the purpose of establishing this diagnose, but also the institution of a prompt treatment, for the patients presenting postoperative symptoms such as ocular pain, a reduction in visual acuity unilateral or bilateral, conjunctival hyperemia, cephalalgia or nausea, with the mention that some symptoms may be disguised by postoperative administration of painkillers or attributed to general anesthesia. The predictability of occurrence in case of acute angle closure after general anesthesia is low and the preventive measures have not been generally established yet [3]. Notwithstanding the majority of anesthetics are associated with intraocular hypotension, there are a series of factors presented in Yukie N.'s study which lead to the increase of IOP perianesthetic: endotracheal intubation, extubation, hypoxia, hypertension spikes and mydriasis.…”

Does restrictive fluid strategy during robotic pelvic surgeries obtund intraoperative rise in intraocular pressure?

“…[ 14 ] In general, any postoperative patient with complaints of red eyes, visual disturbances, eye pain, headache, and nausea should undergo a timely examination by an ophthalmologist as all patients should be considered at risk of acute angle-closure glaucoma. [ 15 ]…”

Anesthetıc Management in Glaucoma Surgery

“…Deep anesthesia induced by anesthetics at concentrations higher than that of clinical use, postoperative care in a darkened room, psychological stress, and parasympatholytic drugs (such as atropine and scopolamine) or sympathomimetic drugs (such as phenylephrine and ephedrine) have been associated with mydriasis. 50 Although high concentrations of inhalation anesthetic drugs can cause mydriasis, the concentrations of inhalation anesthetic drugs that induce mydriasis are considered to be far higher than the clinical concentrations. 50 Sympathomimetic drugs dilate the pupil and elevate blood pressure significantly.…”

“…50 Although high concentrations of inhalation anesthetic drugs can cause mydriasis, the concentrations of inhalation anesthetic drugs that induce mydriasis are considered to be far higher than the clinical concentrations. 50 Sympathomimetic drugs dilate the pupil and elevate blood pressure significantly. These drugs may also cause acute angle closure glaucoma (AACG) in patients with a predisposing condition.…”

“…For this reason, in cases of known and untreated AACG, ephedrine is contraindicated. 50 Although anticholinergics, given as antisialogogues, have little effect on IOP when given intramuscularly before the arrival at the operating theatre or intravenously at induction, atropine should not be used in the presence of narrow chamber angles. 45 Propofol administered during induction of anesthesia causes a significant decrease in blood pressure, which is especially important for the elderly.…”