Ulus Travma Acil Cerrahi Derg. 2022; 28(5): 711-713 | DOI: 10.14744/tjtes.2020.67932

Orbital compartment syndrome secondary to retrobulbar hematoma after infratrochlear nerve block for nasolacrimal probing

Ceyhun Arýcý, Busenur Gönen, Burak Mergen, Ahmet Murat Sarýcý
Department of Ophthalmology, Ýstanbul University-Cerrahpaþa, Cerrahpaþa Faculty of Medicine, Ýstanbul-Turkey

After infratrochlear nerve block for nasolacrimal probing, sudden vision loss, proptosis, pain, loss of light reflexes, and a total limitation of ocular movement was observed in a 71-year-old female patient. She was diagnosed with retrobulbar hemorrhage and orbital compartment syndrome (OCS). Lateral canthotomy, cantholysis, and medial orbitotomy were performed on the patient. She was not taking any oral anticoagulant medication and did not have any disease other than hypothyroidism and systemic hy-pertension. All the clinical findings returned to normal right after the intervention except mild ptosis (~1 mm), which persisted for 2 months. All patients scheduled for periocular anesthesia should be questioned about using oral anticoagulant medications, and the possibility of serious complications should be kept in mind even for patients without any risk factors. Patients with OCS secondary to retrobulbar hemorrhage should be surgically managed within the critical window (90 min) to prevent any irrevers-ible optic nerve injury.

Keywords: Infratrochlear nerve block, orbital compartment syndrome; periocular anesthesia; probing; retrobulbar hemorrhage.

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Nazolakrimal probing için yapýlan infratrochlear sinir bloðu sonrasý geliþen retrobulbar hematom nedenli orbital kompartman sendromu

Ceyhun Arýcý, Busenur Gönen, Burak Mergen, Ahmet Murat Sarýcý
Ýstanbul Üniversitesi-Cerrahpaþa Cerrahpaþa Týp Fakültesi, Göz Hastalýklarý Anabilim Dalý, Ýstanbul

Yetmiþ bir yaþýnda kadýn hastada nazolakrimal probing iþlemi için yapýlan infratrochlear sinir bloðu sonrasý ani görme kaybý, ýþýk refleksi kaybý, prop-tozis ve göz hareketlerinin total kýsýtlanmasý gözlendi. Hastaya retrobulbar hemoraji nedenli orbital kompartman sendromu tanýsý kondu ve lateral kantotomi, kantoliz ve medial orbitotomi yapýldý. Hastanýn herhangi bir oral antikoagülan ilaç veya hipotiroidi ve sistemik hipertansiyon dýþýnda her-hangi bir sistemik hastalýk öyküsü yoktu. Hastanýn iki ay persiste eden hafif ptozisi (~1 mm) dýþýndaki tüm klinik bulgularý normale döndü. Perioküler anestezi iþlemi planlanan tüm hastalar antikoagülan ilaç kullanýmý açýsýndan sorgulanmalý, fakat herhangi bir risk faktörü olmayan bir hastada bile bu iþlemler sýrasýnda ciddi komplikasyonlar geliþebileceði mutlaka akýlda tutulmalýdýr. Retrobulbar hemoraji nedenli orbital kompartman sendromu geliþen hastalara geri dönüþsüz optik sinir hasarý oluþumunu engellemek adýna kritik sürede (90 dakika) cerrahi müdahale uygulanmalýdýr.

Anahtar Kelimeler: Infratrochlear sinir bloðu, orbital kompartman sendromu; perioküler anestezi; probing; retrobulbar hemoraji.

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