Blindness

Eye injuries represent 4% of claims analyzed in the ASA Closed Claims Project.

Majority of entries in the ASA POVL Registry are associated with cardiac and spine cases, with a reported incidence as high as 4.5% and 0.2%, respectively. Other surgical procedures with POVL reported including head and neck, liver transplants, thoracoabdominal aneurysm resections, peripheral vascular procedures, and prostatectomies.

In the Registry, POVL is most often associated with ION 89% of the time and CRAO 11% of the time.

Blindness can result from injury to the eye, its surrounding structures (eyelid and conjunctiva), blood supply, and optic nerve.

Blindness may be transient (glycine absorption), prolonged, or permanent (ION, CRAO, traumatic, and central ischemic events).

ION: Bilateral blindness in spine procedures in the prone position, cardiopulmonary bypass, head and neck dissections, complex instrumented spinal fusion surgery, where there is significant facial swelling and venous hemodynamics may be altered (highest incidence: Pts <18 y)

CRAO: Periocular trauma and rarely bilateral blindness.

• Procedure dependent factors: improper head positioning, use of a horseshoe headrest when placing the eye in contact with the headrest, anemia, blood loss greater than 1 L, systemic hypotension, and procedure duration greater than 6 h

Intraocular procedures, procedures around the eye, prone position with padding around the face and eyes, exophthalmos, or ophthalmic nerve blocks

• 1.5% glycine irrigation during TURP as well as transurethral bladder procedures and hysteroscopic procedures in women

Pressure on the globe or contact with eye by foreign objects or solutions

Positioning of pt, especially prone

Low blood-flow states: Systemic hypotension, anemia, and venous drainage impairment of the head and neck

Operations in physical proximity to the eyes

During ophthalmic surgery:

• Movement of pt under either MAC or GA during intraocular surgery

• Trauma to optic nerve, retinal artery, or vein during orbital or sinus surgery

• Coughing or substantial Valsalva maneuvers by pt following intraocular surgery

During ophthalmic nerve block:

• Perforation of globe

• Trauma to the optic nerve, retinal artery, and vein

Unless associated with glycine irrigating solution, blindness is often an irreversible complication following anesthesia and surgery.

Blindness is most often associated with injury to the eye, its surrounding structures (eyelid and conjunctive), blood supply, and optic nerve.