Unilateral Visual Loss after a Nasal Airway Surgery

Abstract

Septoplasty and turbinoplasty are common ear, nose, throat (ENT) operations which generally have low complication rates. A 45-year-old man had a septoplasty operation and a right turbinoplasty operation under a combined general and local anesthetic. He woke from the procedure with a reduced visual acuity in the right eye and substantial inferior visual field loss. A review of the current literature focuses on the vasospasm effects of local anesthetic, in combination with epinephrine on the intricately linked nasal and orbital vascular supply.

Complications in septoplasty based on a large group of 5639 patients

“…Limited studies have been done to investigate the rate of dental anesthesia of the upper incisors after septoplasty surgery, but it is a potential complication [ 11 ]. Ocular complication, including blindness, are very rare, but do occur [ 23 , 24 ]. The theory for complete visual loss after septoplasty is that when epinephrine is injected under pressure into the mucosa of the septum or tissue surrounding the inferior turbinate there is a risk of a retrograde flow through the anterior ethmoidal artery into the ophthalmic artery, which can cause vasospasm of the end arteries to the optic nerve and retina.…”

Ocular Blood Flow Alterations during Inferior Turbinate Radiofrequency Reduction under Local Anesthesia

“…11 However, it cannot completely explain vision loss after other nasal surgeries because of the lack of embolic risk factors of patients, as discussed in the literature. 18 Savino et al 12 and McGrew et al 13 reviewed multiple cases and indicated that visual loss was due to vasospasm induced by submucosal injection under pressure of anesthetics with epinephrine. This theory has been supported by other investigators.…”

“…This theory has been supported by other investigators. 9,10,18 Acute vision loss after local anesthetic injections occurs not only during rhinologic surgeries but also during other surgeries, such as cataract or dental surgeries. 19 Huber and Remky 20 designed a prospective study to investigate the effect of retrobulbar anesthesia on retrobulbar hemodynamics during cataract surgery.…”