Sprung J, Haddox JD, Maitra-D’Cruze AM. Horner’s syndrome and trigeminal nerve palsy following epidural anaesthesia for obstetrics. Can J Anaesthesia 38(6): 767–771, 1991.

Sullivan KL, et al. Retrobulbar anesthesia and retinal vascular obstruction. Ophthalmology 90: 373, 1983.

Ursell PG, Spalton DJ. The effect of solution temperature on the pain of peribulbar anesthesia. Ophthalmology 103(5): 839–841, 1996.

Walker M, Drangsholt M, Czartoski TJ, et al. Dental diplopia with transient abducens palsy. Neurology 63: 2449–2450, 2004.

Wittpenn JR, et al. Respiratory arrest following retrobulbar anesthesia. ­Ophthalmology 93: 867, 1986.

Class: Therapeutic Gases

Generic name: Carbon dioxide.

Proprietary name: None.

Primary use

This odorless, colorless gas is used as a respiratory stimulant to increase cerebral blood flow and in the maintenance of acid-base balance.

Ocular side effects

Systemic administration – extreme concentrations

Certain

 1. Decreased vision

 2. Decreased convergence

 3. Paralysis of accommodation

 4. Decreased dark adaptation

 5. Photophobia

 6. Visual fields

a.Constriction

b.Enlarged blind spot

 7. Problems with color vision

a.Color vision defect

b.Objects have yellow tinge

 8. Retinal vascular engorgement

 9. Pupils

a.Mydriasis

b.Absence of reaction to light 10.Visual hallucinations

11.Diplopia

12.Abnormal conjugate deviations

13.Papilledema

14.Increased intraocular pressure

15.Ptosis

16.Decreased corneal reflex

17.Proptosis

18.Decreased ability to detect coherent motion

Clinical significance

Although ocular side effects due to carbon dioxide are numerous, they are rare and nearly all significant findings are in toxic states. Transient elevation of intraocular pressure has been reported in the inhalation of 10% carbon dioxide. It is of interest in evaluating ‘sick building syndrome’ (Hempel-Jorgensen et al 1997; Kjaergaard et al 1992) that the percentage of CO2 in the air may be correlated with ocular stinging and discomfort. Yang (1997) reported that a 2.5% rise in CO2 in the air may cause temporary impairment of the ability to detect coherent motion.

References And Further Reading

Duke-Elder S. Systems of Ophthalmology, Vol. XIV, Part 2, Mosby, St Louis, pp 1350–1351, 1972.

Dumont L, Mardirosoff C, Dumont C, et al. Bilateral mydriasis during laparoscopic surgery. Acta Anaesthesiologica Belgica 49(1): 33–37, 1998.

Freedman A, Sevel D. The cerebro-ocular effects of carbon dioxide poisoning. Arch Ophthalmol 76: 59, 1966.

Hempel-Jorgensen A, Kjaergaard SK, Molhave L. Integration in human eye irritation. Int Arch Occup Environ Health 69(4): 289–294, 1997.

Kjaergaard S, Pedersen OF, Molhave L. Sensitivity of the eyes to airborne irritant stimuli: Influence of individual characteristics. Int Arch Occup Environ Health 47(1): 45–50, 1992.

Lincoff A, et al. Selection of xenon gas for rapidly disappearing retinal ­tamponade. Arch Ophthalmol 100: 996–997, 1982.

Podlekareva D, Pan Z, Kjaergaard S, et al. Irritation of the human eye mucous­ membrane caused by airborne pollutants. Int Arch Occup Environ Health 75: 359–364, 2002.

Sevel D, Freedman A. Cerebro-retinal degeneration due to carbon dioxide poisoning. Br J Ophthalmol 51: 475, 1967.

Sieker NO, Nickam JB. Carbon dioxide intoxication: The clinical syndrome, its etiology and management, with particular reference to the use of mechanical respirators. Medicine 35: 389, 1956.

Walsh FB, Noyt WF. Clinical Neuro-Ophthalmology 3rd edn, Vol. III, Williams & Wilkins, Baltimore, pp 2601–2602, 1969.

Wolbarsht ML, et al. Speculation on carbon dioxide and retrolental fibroplasia. Pediatrics 71: 859, 1983.

Yang Y, Sun C, Sun M. The effect of moderately increased CO2 concentration on perception of coherent motion. Aviation Space Environ Med 68(3): 187–191, 1997.

Generic names: Oxygen, oxygen-ozone.

Proprietary names: None.

Primary use

This colorless, odorless, tasteless gas is used in inhalation anesthesia and in hypoxia. Oxygen-ozone (O2O3) is used as intradiscal injections for the treatment of lumbar sciatic pain ­peridurally and lumbar disc herniation.

Ocular side effects

Systemic administration

Certain

 1. Retinal vascular changes

a.Constriction

b.Spasms

c.Hemorrhages (Fig. 7.4d)

 2. Decreased vision

 3. Visual fields

a.Constriction

 4. Retrolental fibroplasia – in newborns or young infants

 5. Heightened color perception

 6. Retinal detachment

 7. Abnormal ERG

 8. Decreased dark adaptation

 9. Myopia

10.Cataracts – nuclear

Possible

1. Retinal hemorrhage (oxygen-ozone) (Fig. 7.4d)

•anesthesia4 Sectionin used Agents