Seaberg RR, Freeman WR, Goldbaum MH, et al. Permanent postoperative vision loss associated with expansion of intraocular gas in the presence of nitrous oxide-containing anesthetic. Anesthesiology 97: 1309–1310, 2002.

Sebel PS, Flynn PJ, Ingram DA. Effect of nitrous oxide on visual, auditory and somatosensory evoked potentials. Br J Anaesth 56: 1403, 1984.

Vote BJ, Hart RH, Worsley DR, et al. Visual loss after use of nitrous oxide gas with general anesthetic in patients with intraocular gas still persistent up to 30 days after vitrectomy. Anesthesiology 97: 1305–1308, 2002.

Wolf GE, Capuano C, Hartung J. Effect of nitrous oxide on gas bubble volume in the anterior chamber. Arch Ophthalmol 103: 418–419, 1985.

Yang YF, Herber L, Rüschen RJ, Colling RJ. Nitrous oxide anaesthesia in the presence of intraocular gas can cause irreversible blindness. BMJ 325: 532–533, 2002.

Generic name: Propofol.

Proprietary name: Diprivan.

Primary use

An intravenous sedative-hypnotic used in the induction and maintenance of anesthesia or sedation.

with a single low-dose bolus intravenous sedation before cataract surgery there was a moderate reduction in intraocular pressure.

Reddy (2002) reported that as an anesthetist he inadvertently got this liquid drug on his eyes and experienced intense burning for several minutes until his eye could be irrigated. He could not continue giving the anesthetic as he was experiencing a complete loss of vision. Ameen (2001) had a similar experience but could continue and eventually developed a keratitis, which resolved without sequelae.

References and Further Reading

Ameen H. Can propofol cause keratitis? Anaesthesia 56: 1017–1018, 2001. Kumar CM, McNeela BJ. Ocular manifestation of propofol allergy. Anaes-

thesia 44: 266, 1989.

Lenart SB, Garrity JA. Eye care for patients receiving neuromuscular blocking agents or propofol during mechanical ventilation. Am J Crit Care 9: 188–191, 2000.

Marsch SC, Schaefer HG. External ophthalmoplegia after total intravenous anaesthesia. Anaesthesia 49(6): 525–527, 1994.

Marsch SCU, Schaefer HG. Problems with eye opening after propofol anesthesia­ . Anesth Analg 70: 127–128, 1990.

Neel S, Deitch R, Moorthy SS, et al. Changes in intraocular pressure during low dose intravenous sedation with propofol before cataract surgery.

Br J Ophthalmol 79: 1093–1097, 1995.

Reddy MB. Can propofol cause keratitis? Anaesthesia 57: 183–208, 2002.

Ocular side effects

Intravenous administration

Certain

1. Extraocular muscles

a.Diplopia

b.Palsy

c.Paresis

d.External ophthalmoplegia 2. Inability to open eyes

3. Eyelids

a.Rash

b.Edema

Probable

1. Blurred vision

2. Nystagmus

Accidental ocular exposure

Certain

1. Intense ocular burning

2. Temporary blindness

3. Keratitis

Clinical significance

Propofol is an intravenous medication that can cause transitory visual complications. To date, none of the reported events in the literature or in the National Registry have been permanent. One of the more unusual side effects is that after patients have recovered from anesthesia (i.e. respond to verbal commands and have a return of muscular power) they are unable to open their eyes either spontaneously or in response to a command for 3–20 minutes. This may include the transitory loss of all ocular or periocular muscle movements, including the lids and rectus muscles. Blurred vision can occur, but it is usually inconsequential. Associated exposure keratitis occurs due to lack of eyelid control and restriction of Bell’s phenomena. While nystagmus has been reported to the National Registry, it is difficult to prove a cause-and-effect relationship. Neel et al (1995) reported that

Class: Local Anesthetics

Generic names: 1. Bupivacaine hydrochloride; 2. chloroprocaine hydrochloride; 3. lidocaine; 4. mepivacaine hydrochloride; 5. prilocaine; 6. procaine hydrochloride.

Proprietary names: 1. Sensorcaine, Marcaine Hydrochloride; 2. Nescaine, Nescaine-MPF; 3. Anestacon, Laryng-o-jet kit, Lidoderm, Lidopen, LTA II Kit, Xylocaine, Xylocaine Viscous; 4. Carbocaine, Isocaine Hydrochloride, Polocaine, Polo- caine-MPF, Scandonest Plain; 5. Citanest Plain; 6. Novocain.

Primary use

These amides or esters of para-aminobenzoic acid are used in infiltrative, epidural block and peripheral or sympathetic nerve block anesthesia or analgesia.

Ocular side effects

Systemic administration – spiral, caudal, epidural, extradural injections

Certain

1. Extraocular muscles

a.Paresis or paralysis (Fig. 7.4c)

b.Diplopia

c.Nystagmus

d.Jerky pursuit movements – toxic states

e.Abnormal doll’s head movements – toxic states 2. Decreased vision

3. Horner’s syndrome

a.Miosis

b.Ptosis 4. Pupils

a.Mydriasis – toxic states

b.Anisocoria – toxic states

5. Problems with color vision – color vision defect (lidocaine) 6. Visual hallucinations (lidocaine)