ABSTRACT
The authors describe six complications, of retrobulbar injections documented by fundus photography and fluorescein angiography. These include (1) injection of corticosteroid into the posterior ciliary arterial circulation resulting in emboli in the vasculature of the choroid and the optic nerve head; (2) injection of corticosteroid into the ophthalmic artery resulting in emboli in both the choroidal and retinal circulations; (3) presumed injection of lidocaine and air into the optic nerve sheath adjacent to the globe with extension anteriorly into the subretinal space and the space between the posterior vitreous and the internal limiting membrane; (4) occlusion of the central retinal artery without an associated retrobulbar hemorrhage; (5) trauma to and partial injection of lidocaine in the central retinal artery with embolization into the retinal circulation; and (6) presumed injection of lidocaine into the optic nerve sheath producing a combined central retinal vein and artery occlusion. Alternative techniques that might decrease the incidence of complications associated with retrobulbar injections are discussed.
Subject(s)
Eye Diseases/etiology , Injections/adverse effects , Adult , Arterial Occlusive Diseases/etiology , Choroid/blood supply , Embolism/etiology , Embolism, Air/etiology , Female , Hemorrhage/etiology , Humans , Male , Middle Aged , Optic Nerve/blood supply , Retinal Artery , Retinal Vein Occlusion/etiology , Retinal VesselsABSTRACT
Fifty patients underwent ophthalmologic examination before and after bilateral upper dorsal sympathectomy performed for palmar hyperhidrosis. Postoperative examination was done during the first week, at 3 to 4 weeks and at 6 to 12 months after the operation. Immediately after surgery there were 18 patients with ptosis (6 severe) and 23 with miosis (12 severe). There were 19 patients with excessive lacrimation and some degree of congestion of conjunctival blood vessels was present in almost all patients. Uniocular decrease in tears was present in 2 patients. Most of these manifestations decreased with passage of time. At one year there remained only 3 patients with severe ptosis and 4 with severe miosis. The results suggest that the classical anatomic explanation of Horner's syndrome may require some modification.