Posterior Ischaemic Optic Neuropathy after Intranasal Anesthetic Injection: Case Report with OCT Findings

Abstract

A 42 year-old man underwent a nasal septoplasty and awoke with vision of light perception in his right eye. An afferent pupillary defect was noted with a normal fundus examination, normal fluorescein angiography and intact optic canal on imaging studies. A diagnosis of posterior ischaemic optic neuropathy was made. No visual improvement was noted in our case despite treatment with high dose oral steroids. Follow-up showed optic atrophy on fundoscopy and retinal nerve fiber layer thinning on OCT. Visual loss after nasal septoplasty surgery is extremely rare, with few cases reported in the literature. It can occur if the optic canal is fractured, but has been most commonly reported as a complication of intranasal anesthetic injections. Vigorous pressure during injection can overcome arterial pressure causing the injected material to circulate in a retrograde manner via arterial branches and cause ischaemia of the optic nerve. A further possibility is that intranasal injection could cause emboli to enter the optic nerve circulation. Physicians should be aware of this potentially blinding complication after intranasal anesthetic injections.

Keywords:

• intranasal anesthetic injection
• nasal septoplasty
• posterior ischaemic optic neuropathy