Chapter 82
- Postoperative Visual Loss
- Steven Roth
Visual loss after anesthesia and surgery is a rare, but unexpected
and devastating complication. The incidence of visual loss postoperatively has been
estimated at 0.003%[1]
and 0.0008%.[2]
However, because of concern about litigation, these injuries may be underreported
in the medical literature. In the American Society of Anesthesiologists (ASA) Closed
Claims Study, which analyzed only cases in which litigation was involved, eye injuries
accounted for just 3% of all claims, yet were responsible for relatively high monetary
awards,[3]
thus further indicating the serious nature
of permanent eye injury in the perioperative period. In recent years, there has
been heightened awareness of the possibility of visual loss after anesthesia for
nonocular surgery and an impression, though yet unproven, that the incidence is on
the rise.
Symptoms and signs of eye injury associated with visual loss may
be subtle and are not generally familiar to most anesthesiologists. Except for extensive
consideration of the impact of anesthetic agents on intraocular pressure (IOP), relatively
few data are available on the effect of anesthesia on visual function. This chapter
will familiarize anesthesiologists with the incidence, risk factors, diagnosis, and
treatment of eye injuries leading to visual loss in the perioperative period. The
discussion will focus on severe, unexpected injuries to the eye that follow nonocular
surgery because eye damage after ocular surgery is well described in the ophthalmology
literature. Injuries to the retina and optic nerve (ON) and the visual connections
to the brain will be the focus of this chapter.
