POSTOPERATIVE VISUAL LOSS

👀 Corneal abrasion is the most common ocular complication after general anesthesia

👀 Ischemic Optic neuropathy (ION) and Central Retinal Artery Occlusion (CRAO) are the commonest causes for postoperative visual loss

👀 ISCHEMIC OPTIC NEUROPATHY (ION)

🌵More common among the two

🌵Most often seen after prolonged surgery in prone position 

🌵Venous congestion--> Raised Intra Ocular Pressure (IOP) due to Raised Intra Orbital Pressure --> Intra Orbital ‘Compartment Syndrome’

🌵Hypotension, Diabetes, Vascular disease, Smoking etc also may be important in the etiopathogenesis

🌵Treatment:

➖ Reduce optic nerve edema as it passes through posterior scleral foramen with steroids and mannitol 

➖ Optimal oxygen delivery by ensuring normal blood pressure and hematocrit  

➖ Clear all obstruction to venous drainage 

🌵Chance of visual recovery is less

👀 CENTRAL RETINAL ARTERY OCCLUSION (CRAO)

🌵 External pressure on eye and embolism are risk factors 

🌵 An echocardiogram and carotid ultrasound may help us to find an embolic source

Reference: White E, David DB. Care of the eye during anaesthesia and intensive care. Anaesth Intens Care Med. 2007; 8(9): 383–386.