Sudden Visual Loss and Total Ophthalmoplegia after Brain Surgery

Abstract

A 19-year-old woman underwent an occipital craniotomy for removal of a left intraventricular glioblastoma under general anaesthesia and in prone position. Postoperatively she complained of blindness of the right eye. Ocular examination revealed mild proptosis and total ophthalmoplegia of the right eye. Computerized tomography (CT) of the orbits revealed right exophthalmos and enlargement of the extraocular muscles without optic nerve compression. CT angiography showed dilated right supraorbital and supratrochlear arteries without evidence of emboli. Treatment with intravenous methylprednisolone and oral acetazolamide was given. The ocular motility defect improved but the visual loss persisted. As has been emphasized in many similar situations adequate intra-operative ocular protection may reduce such complications.

Keywords:

• Blindness
• central retinal artery occlusion
• complication of prone surgery
• total ophthalmoplegia