Retinal Vascular Occlusion Secondary to Retrobulbar Injection: Case Report and Literature Review

Abstract

Retrobulbar injection has been widely practiced as a technique of ocular anesthesia for many decades. Nevertheless, the technique is not free from complications. Vascular occlusion secondary to retrobulbar injection is rare but can be vision threatening. We report a case series of two such patients who presented with poor vision following retrobulbar injection. Fundus showed pale retina with cherry red spot suggestive of central retinal artery occlusion in case 1 and pale disc with sclerosed vessels and multiple superficial hemorrhages suggestive of a combined occlusion of retinal artery and vein in case 2. Optical coherence tomography (OCT) showed thickened inner retinal layers with intact outer retinal layers in case 1 and thinning in case 2. We conclude that retrobulbar injections can rarely be associated with dreadful vision-threatening complications like in our patients. We also report the role of OCT in assessing the prognosis following vascular occlusion.

Keywords: Combined occlusion; retrobulbar injection; vascular occlusion.

Figure 1

Central retinal artery occlusion. (a) Fundus picture showing retinal whitening in the posterior pole with cherry red spot suggestive of central retinal artery occlusion, (b) fundus fluorescein angiography taken on the next day showing normal arm retinal time with delayed arterio-venous time suggestive of reperfusion, (c) optical coherence tomography shows hyperreflective inner retinal layers with thickening and an intact outer retina suggestive of central retinal artery occlusion. Inner retinal layers are edematous and fused due to an acute ischemic event

Figure 2

Combined occlusion of central retinal artery and vein. (a) Fundus image (montage) shows pale disc, sclerosed vessels, and intraretinal hemorrhages in all quadrants suggestive of combined occlusion, (b) fundus fluorescein angiography shows occluded artery (arrow head) and occluded vein (arrow), (c) optical coherence tomography shows thin and atrophic retinal layers suggestive of a long-standing vascular occlusion