Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-17T16:27:59.358Z Has data issue: false hasContentIssue false

23 - Eye Trauma and Anesthesia

Published online by Cambridge University Press:  18 January 2010

Martin Dauber
Affiliation:
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
Steven Roth
Affiliation:
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
Get access

Summary

Objectives

  1. Define the basic anatomic and physiologic concepts of ocular trauma.

  2. Review the anesthetic implications of eye injuries, including blindness following major surgery.

  3. Evaluate the use of succinylcholine in patients with open-globe injuries.

INTRODUCTION

Trauma to the eyes and resulting blindness can have life-altering impact. This chapter will present the implications for the anesthesiologist of trauma to the eye. Ocular trauma and basic anatomic and physiologic concepts will be defined and the incidence of these potentially devastating injuries will be reviewed. Anesthetic implications, including the timing of surgery, anesthetic drug selection, and other perianesthetic concerns will be addressed. The use of succinylcholine in patients with open-globe injuries is a long-standing controversy that we will discuss. Blindness following major trauma and resuscitation has significant implications for physicians caring for trauma patients.

DEFINITION

A standard terminology for eye injury that has been adopted in the United States and internationally is known as the Birmingham Eye Trauma Terminology (BETT; Figure 23.1). The entire globe is considered, and the BETT is unambiguous, consistent, and simple to use. The definitions it provides will be utilized in this chapter. The BETT system clearly defines all injuries and places each type of injury within a comprehensive system of the whole eyeball [1].

The eye wall is defined as the cornea and the sclera. A full-thickness wound of these layers is an “open-globe” injury, whereas a “closed-globe” injury does not involve a full-thickness wound (Figure 23.2, see also color plate after p. 294).

Type
Chapter
Information
Trauma Anesthesia , pp. 360 - 366
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kuhn, F, Morris, R, Witherspoon, CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin N Am. 2002;15(2):139–43.CrossRefGoogle ScholarPubMed
National Society to Prevent Blindness. Vision Problems in the U.S. – Data Analysis, National Society to Prevent Blindness, Chicago, Illinois, 2002.
United States Consumer Product Safety Commission, Directorate for Epidemiology; National Injury Information Clearinghouse. National Electronic Injury Surveillance System. Product Summary Report. U.S. Consumer Product Safety Commission, Bethesda, Maryland, 2003.
Official Rules of Racquetball. USA Racquetball Association, September 2004. Available at: http://usra.org/Rulebook/tabid/839/Default.aspx.
Grove, AS.Computerized tomography in management of orbital trauma. Ophthalmology 1982;89:433–40.CrossRefGoogle ScholarPubMed
Harlan, JB, Pieramici, DJ.Evaluation of patients with ocular trauma. Ophthalmol Clin N Am 2002;15(2):153–61.CrossRefGoogle ScholarPubMed
Koltai, PJ, Amjad, I, Meyer, D, Feustel, PJ.Orbital fractures in children. [Journal Article. Research Support, U.S.P.H.S.] Arch Otolaryngol Head Neck Surg 1995;121(12):1375–9.Google ScholarPubMed
McGoldrick KE, Gayer S. Anesthesia and the eye. In: Clinical Anesthesia, fifth edition. Edited by Barash, P, Cullen, B, Stoelting, R, Williams, Lippincott and Wilkins, , Philadelphia PA. 2006, pp 974–96.Google Scholar
Forrester, JV, Dick, AD, et al. The Eye: Basic Sciences in Practice. Philadelphia: WB Saunders, 2002.Google Scholar
Foldes, FF, Menall, PG, Borrego-Hinojosa, JM. Succinylcholine: A new approach to muscular relaxation in anesthesiology. N Engl J Med 1952;247:596–600.CrossRefGoogle ScholarPubMed
Hofman, H, Holzer, H, Bock, J, et al. The effect of muscle relaxants on intraocular pressure. Klin Monatsbl Augenheilk 1953;123:1–15.Google Scholar
Lincoff, HA, Breinin, GM, Devoe, AG. The effect of succinylcholine on the extraocular muscles. Am J Ophthalmol 1957; 43:440–4.CrossRefGoogle ScholarPubMed
Dillon, JB, Sabawala, P, Taylor, DB, et al. Action of succinylcholine on eye muscles and intraocular pressure. Anesthesiology 1957;18:44–9.CrossRefGoogle ScholarPubMed
Libonati, MM, Leahy, JJ, Ellison, N.The use of succinylcholine in open eye surgery. Anesthesiology 1986;62:637–40.CrossRefGoogle Scholar
Rich, AL, Witherspoon, CD, Morris, RE, et al. Use of nondepolarizing anesthetic agents in penetrating ocular injuries. Anesthesiology 1986;65:108–9.CrossRefGoogle ScholarPubMed
Donlon, JV. Succinylcholine and open eye injuries. Anesthesiology 1986;65:526–7.Google Scholar
Moreno, RJ, Kloess, P, Carlson, DW. Effect of succinylcholine on the intraocular contents of open globes. Ophthalmology 1991;98:636–8.CrossRefGoogle ScholarPubMed
Kelly, RE, Dinner, M, Turner, LS, et al. Succinylcholine increases intraocular pressure in the human eye with the extraocular muscles detached. Anesthesiology 1993;79:948–52.CrossRefGoogle ScholarPubMed
Metz, HS, Venkatesh, B.Succinylcholine and intraocular pressure. J Pediatr Ophthalmol Strabismus 1981;18:12–4.Google ScholarPubMed
Verma, RS.“Self-Taming” of succinylcholine-induced fasciculations and intraocular pressure. Anesthesiology 1979;50:245.CrossRefGoogle ScholarPubMed
Mahajan, RP, Grover, VK, Munjal, VP, et al. Double blind comparison of lidocaine, tubocurarine and diazepam pretreatment in modifying intraocular pressure increases. Can J Anaesth 1987;34(1):41–5.CrossRefGoogle ScholarPubMed
Alexander, R, Hill, R, Lipham, WJ, et al. Remifentanil prevents an increase in intraocular pressure after succinylcholine and tracheal intubation. Br J Anaesth 1998;81:606–7.CrossRefGoogle ScholarPubMed
Georgiou, M, Parlapani, A, Argiriadou, H, et al. Sufentanil or clonidine for blunting the increase in intraocular pressure during rapid-sequence induction. Eur J Anaesthesiol 2002;19(11);819–22.CrossRefGoogle ScholarPubMed
Sweeney, J, Underhill, S, Dowd, T, et al. Modification by fentanyl and alfentanil of the intraocular pressure response to suxamthonium and tracheal intubation. Br J Anaesth 1989;63:688–91.CrossRefGoogle Scholar
Indu, B, Batra, YK, Puri, GD, et al. Nifidipine attenuates the intraocular pressure response to intubation following succinylcholine. Can J Anaesth 1989;36:269–72.CrossRefGoogle Scholar
Mahajan, RP, Grover, VK, Sharma, SL, et al. Intranasal nitroglycerine and intraocular pressure during general anesthesia. Anesth Analg 1988;67(7):631–6.CrossRefGoogle ScholarPubMed
Cook, JH, Feneck, RO, Smith, MB. Effect of pre-treatment with propranolol on intra-ocular pressure changes during induction of anesthesia. Eur J Anaesthesiol 1986;3(6):449–57.Google Scholar
Shapira, OM, Kimmel, WA, Lindsey, PS, et al. Anterior ischemic optic neuropathy after open heart operations. Ann Thorac Surg 1996;61:660–6.CrossRefGoogle ScholarPubMed
Shahian, DM, Speert, PK.Symptomatic visual deficits after open heart operations. Ann Thorac Surg 1989;48:275–9.CrossRefGoogle ScholarPubMed
Sweeney, PJ, Breuer, AC, Selhorst, JB, et al. Ischemic optic neuropathy: a complication of cardiopulmonary bypass surgery. Neurology 1982;32:560–2.CrossRefGoogle ScholarPubMed
Roth, S, Thisted, RA, Erickson, JP, et al. Eye injuries after non ocular surgery: a study of 60,965 anesthetics from 1988 to 1992. Anesthesiology 1996;85:1020–7.CrossRefGoogle Scholar
Roth, S, Nunez, R, Schreider, BD. Visual loss after lumbar spine fusion. J Neurosurg Anesthesiol 1997;9:346–8.CrossRefGoogle Scholar
Chutkow, JG, Sharbrough, FW, Riley, FC. Blindness following simultaneous bilateral neck dissection. Mayo Clin Proc 1973;48:713–7.Google ScholarPubMed
Buus, DR, Tse, DT, Farris, BK. Ophthalmic complications of sinus surgery. Ophthalmology 1990;97:612–9.CrossRefGoogle ScholarPubMed
Maniglia, AJ.Fatal and major complications secondary to nasal and sinus surgery. Laryngoscope 1989;99:276–83.Google ScholarPubMed
Warner, ME, Warner, MA, Garrity, JA, et al. The frequency of perioperative vision loss. Anesth Analg 2001;93:1417–21.CrossRefGoogle ScholarPubMed
Brown, RH, Schauble, JF, Miller, NR. Anemia and hypotension as contributors to perioperative loss of vision. Anesthesiology 1994;80:222–6.CrossRefGoogle ScholarPubMed
Chun, DB, Levin, DK.Ischemic optic neuropathy after hemorrhage from a cornual ectopic gestation. Am J Obstet Gynecol 1997;177:1550–2.CrossRefGoogle ScholarPubMed
Gupta, M, Puri, P, Rennie, IG. Anterior ischemic optic neuropathy after emergency caesarean section under epidural anesthesia. Acta Anaesthiol Scand 2002;46:751–2.CrossRefGoogle ScholarPubMed
Williams, GC, Lee, AG, Adler, HL, et al. Bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion after radical prostatectomy. J Urol 1999;162:1384–5.CrossRefGoogle ScholarPubMed
Minagar, A, Schatz, NJ, Glaser, JS. Liposuction and ischemic optic neuropathy: case report and review of literature. J Neurol Sci 2000;181:132–6.CrossRefGoogle ScholarPubMed
Roth, S.The effects of isovolumic hemodilution on ocular blood flow. Exp Eye Res 1992;55:59–63.CrossRefGoogle ScholarPubMed
Katz, DM, Trobe, JD, Cornblath, WT, et al. Ischemic optic neuropathy after lumbar spine surgery. Arch Ophthalmol 1994;112:925–31.CrossRefGoogle ScholarPubMed
Lee, AG.Ischemic optic neuropathy following lumbar spine surgery. J Neurosurg 1995;83:348–9.CrossRefGoogle ScholarPubMed
Roth, S, Barach, P.Post-operative visual loss: still no answers yet. Anesthesiology 2001;95:575–6.CrossRefGoogle Scholar
Lee, , Lam, AM. Unilateral blindness after prone lumbar surgery. Anesthesiology 2001;95:793–5.CrossRefGoogle Scholar
Anonymous. Consensus conference: perioperative red blood cell transfusion. JAMA 1988;260:2700–3.CrossRef
Anonymous. Practice guidelines for blood component therapy: A report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology 1996;84:732–47.CrossRef
Williams, EL, Hart, WM, Tempelhoff, R. Postoperative ischemic optic neuropathy. Anesth Analg 1995;80:1018–29.Google ScholarPubMed
Roth S, Gillesberg I. Injuries to the visual system and other sense organs. In Benumof, JL, Saidman, LJ, ed. Anesthesia and Perioperative Complications, 2nd edition. St. Louis: Mosby, 1999, pp 377–408.Google Scholar
Hayreh, SS. Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis. Ophthalmology 1987;94:1488–502.CrossRefGoogle ScholarPubMed
Roth, S, Pietrzyk, Z.Blood flow after retinal ischemia in cats. Invest Ophthalmol Vis Sci 1994;35:3209–17.Google ScholarPubMed
Cullinane, DC, Jenkins, JM, Reddy, S, et al. Anterior ischemic optic neuropathy: A complication after systemic inflammatory response syndrome. J Trauma 2000;48:381–7.CrossRefGoogle ScholarPubMed
Rassam, SM, Patel, V, Kohner, EM. The effect of acetazolamide on the retinal circulation. Eye 1993;7:697–702.CrossRefGoogle ScholarPubMed
Hayreh, SS. Anterior ischaemic optic neuropathy. III. Treatment, prophylaxis, and differential diagnosis. Br J Ophthalmol 1974;58:981–9.CrossRefGoogle ScholarPubMed
Anonymous. The Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for non-arteritic anterior ischemic optic neuropathy is not effective and may be harmful. JAMA 1995;273:625–32.CrossRef

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Eye Trauma and Anesthesia
    • By Martin Dauber, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, Steven Roth, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.026
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Eye Trauma and Anesthesia
    • By Martin Dauber, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, Steven Roth, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.026
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Eye Trauma and Anesthesia
    • By Martin Dauber, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, Steven Roth, Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.026
Available formats
×