Single medial injection peribulbar anaesthesia using prilocaine.

A prospective randomised study is reported comparing a single peribulbar injection into the medial compartment of the orbit and the standard two injection peribulbar technique. One hundred and seven patients undergoing elective intra-ocular surgery were randomly allocated to receive either a single medial injection, or two injections, using prilocaine 3% with felypressin. Akinesia and pain during surgery were assessed following the injection(s). There was no significant difference in pain during surgery and globe akinesia between the two groups. The single medial peribulbar injection is as effective as two injections using prilocaine 3%.

Peribulbar and retrobulbar anesthesia with prilocaine: a comparison of two methods of local ocular anesthesia.

Prilocaine (Citanest) has been shown to be a satisfactory alternative to lignocaine, with certain important advantages, including superior diffusion. The latter may be especially important in peribulbar anesthesia, where the level of diffusion is a critical factor in providing a timely, high-quality block. In a prospective randomized study, we compared the effectiveness of peribulbar vs retrobulbar administration of prilocaine. Eighty-seven patients undergoing elective intraocular surgery were randomized to receive either retrobulbar or peribulbar anesthesia with prilocaine 3% with felypressin and hyaluronidase. Pain of injection, akinesia, and anesthesia were evaluated at predetermined intervals after injection. Except for the fact that lid akinesia occurred earlier in the peribulbar group, there was no difference in the quality or rate of onset of overall akinesia in the two groups. Nor were there any differences in the pain associated with injection. Both groups had excellent operative anesthesia and akinesia.

Work-related penetrating eye injuries.

A review of all penetrating eye injuries treated at the Manchester Royal Eye Hospital over 5 years (January 1st 1982 to December 31st 1986) was undertaken. There were 258 penetrating eye injuries of which 69 (26.7%) were due to work-related accidents. All were men and 52 (75.4%) of them were under the age of 40 years. Hammering and chiselling were the commonest activities at the time of the injury and accounted for 25 cases (36.2%). Thirty-six patient (52.1%) had intraocular foreign bodies. Thirty-six patients (52.1%) achieved a good visual result (6/12 or better) and 9 had no perception of light, 7 of whom had enucleations. The period of inpatient treatment ranged from 1 to 26 days. From the analysis of the activities at the time of the injury, 61 injuries (88.4%) may be considered to be preventable with appropriate eye protection.

Penetrating eye injuries in road traffic accidents.

A review of all penetrating eye injuries treated by the Manchester Eye Hospital over four years (1 February 1982-31 January 1986) was undertaken. One hundred and ninety-six penetrating eye injuries were seen, of which 16 (8.2%) were due to road traffic accidents. Eight patients (nine eyes) were seen in the 12 months prior to the introduction of the seat-belt legislation on 1 February 1983. None of these patients was wearing a seat-belt whereas two of the eight patients (10 eyes) seen after the seat-belt legislation were. Both these patients suffered severe visual loss due to intraocular glass from shattered windscreens. Three patients had bilateral penetrating eye injuries, one before and two after the seat-belt legislation. Two of the nine eyes involved prior to the legislation and three of the 10 eyes after the legislation had an eventual visual acuity of 6/12 or better. In the majority of patients, failure to wear seat-belts or defective use is to blame. Flying glass from shattered toughened windscreens is a preventable danger. Nine of the 16 patients were first seen in the general accident and emergency department and, of these, seven did not have visual acuities recorded prior to referral to an ophthalmologist. The importance of measurement of the visual acuity and detection of an afferent pupillary defect is stressed based on these findings.

On the management of retained airgun pellets: a survey of 11 orbital cases.

Relevant factors determining the management of inaccessible retained lead airgun pellets are discussed in relation to 11 orbital cases. Although the injuries were of between one month's and 26 years' standing, serum lead levels were normal at under 350 micrograms/l in all instances. This is attributable to the modern alloy composition of the ammunition in question. It is concluded that surgical intervention may be indicated only where there is a mechanical disturbance of ocular motility allied with good visual function.

Candidal endophthalmitis: a manifestation of systemic candidiasis.

Two patients on total parenteral nutrition who developed endophthalmitis secondary to Candida albicans are described. Candidal endophthalmitis as a manifestation of systemic candidiasis is discussed and its early diagnosis by bedside fundal examination in patients at risk is stressed.

Iris prolapse following cataract surgery.

6,485 cases of cataract extraction are reviewed. Iris prolapse was a post-operative complication in 32 cases. (Incidence = 0.49 per cent). It is a relatively uncommon complication of present day cataract surgery, and it is postulated that iris prolapse results from transient pupillary block, in the post-operative period.