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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 852-853

Globe luxation after peribulbar block – The untold story of an iatrogenic complication


1 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
2 Departmet of Ophthalmology, Northern Railway Central Hospital, New Delhi, India

Date of Submission08-Mar-2021
Date of Acceptance13-Jun-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Deepsekhar Das
All India Institute of Medical Sciences, Ward IB, Dr. RP Centre for Ophthalmic Sciences, Ansari Nagar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_262_21

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  Abstract 


Keywords: Complication, globe luxation, iatrogenic, peribulbar block


How to cite this article:
Agrawal S, Bajaj MS, Gupta S, Das D. Globe luxation after peribulbar block – The untold story of an iatrogenic complication. Indian J Ophthalmol Case Rep 2021;1:852-3

How to cite this URL:
Agrawal S, Bajaj MS, Gupta S, Das D. Globe luxation after peribulbar block – The untold story of an iatrogenic complication. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 26];1:852-3. Available from: https://www.ijoreports.in/text.asp?2021/1/4/852/327730

Sahil Agrawal and Saloni Gupta; Equal contribution towards authorship




Globe luxation is a rare clinical event in which there is a complete outward prolapse of eyeball from the orbital cavity with the eyelids closed behind the globe.[1] It usually occurs following trauma or with preexisting diseases like thyroid eye disease, shallow orbits.

We report a 40-year-old female having right eye healed keratopathy with visual acuity of 6/6 and left eye traumatic optic atrophy with no perception of light, posted for right optical iridectomy under peribulbar anesthesia because of a leucomatous corneal opacity occupying the visual axis. There was RAPD in the left eye. She had no history of any systemic illness or thyroid eye disease. On administering 6 mL of peribulbar 2% lidocaine hydrochloride anesthesia (using 26-gauge needle that was inserted through the fornix below the lateral limbus after the lower fornix was exposed by pulling the lower lid down gently), the entire globe luxated anteriorly, with both upper and lower lids lying behind the globe [Figure 1]a. A Desmarres retractor was positioned in upper conjunctival fornix, and the globe pushed back. The eye was patched, and patient was started on oral antiinflammatory medications. After 1 week, the patient was doing well with VER showing good response [Figure 1]b and retained visual acuity of 6/6.
Figure 1: (a) Clinical picture of the patient postadministration of peribulbar anesthesia showing right globe luxation. (b) Clinical picture of the patient at 1-week follow-up

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  Discussion Top


The usual complications of a peribulbar block are conjunctival congestion, eyelid chemosis, globe perforation, retrobulbar hemorrhage, myotoxicity, optic nerve injury, allergic reactions, and oculocardiac reflex.[2] Globe luxation after peribulbar anesthesia has been reported once in a patient who had exophthalmos.[3] Peribulbar block rises intraorbital pressures and any further undue pressure/push over the fornix of the inferior lid by the hub of the needle might push the globe anteriorly. The hub of the needle also acts as a fulcrum against the inferior orbital wall, propelling the globe forwards. This is the probable mechanism for the complication in our case. Care should therefore be taken, especially during early learning period of residency, to avoid excessive pulling of lower lid and any undue pressure by the hub of the needle.

There are two maneuvers described for repositioning a luxated globe.[4] One is performed while asking the patient to look down. The upper eyelid is gently and firmly pulled upward, while the globe is simultaneously repositioned with the index finger of other hand. In the second method, Desmarres retractor is introduced between the upper lid and the globe. Once the tip is under the eyelid, digital manipulation is performed to push the globe into the orbit. A prolonged luxation of the globe might lead to traumatic optic neuropathy and thereby a loss of vision.

Utmost care should be taken while administering blocks, especially during the early learning period of residency, and should always be done under the supervision of a senior well-trained person.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for the images and other clinical information to be reported in the journal. He understands that his name and initials will not be published, and due efforts has been made to conceal the identity of the patient, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zengin N, Karakurt A, Gultan E, Kural G. Traumatic globe luxation. Acta Ophthalmologica 1992;70:844-6.  Back to cited text no. 1
    
2.
Kumar CM. Orbital regional anesthesia: Complications and their prevention. Indian J Ophthalmol Case Rep2006;54:77-84.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Clarke PM, Kozeis N. A complication of peribulbar block in a patient with exophthalmos. Br J Anaesth 1998;81:615.  Back to cited text no. 3
    
4.
Tse DT. A simple maneuver to reposit a subluxed globe. Arch Ophthalmol. 2000;118:410-1.  Back to cited text no. 4
    


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