Postoperative visual loss after anesthesia for nonocular surgery
- Lorri A Lee, MD
Lorri A Lee, MD
- Kadlec Regional Medical Center/Premier Anesthesia
- Nancy J Newman, MD
Nancy J Newman, MD
- Leo Delle Jolley Professor of Ophthalmology
- Emory University
Postoperative visual loss (POVL) is a rare complication of surgery, with increased prevalence after cardiac, spine, head and neck, and some orthopedic procedures. The most common cause of postoperative ocular injury is corneal abrasion, which may or may not be associated with visual loss. The most common causes of permanent POVL are central retinal artery occlusion, ischemic optic neuropathy, and cerebral vision loss.
POVL can occur after injury at any site in the visual pathway, from the cornea to the occipital lobe; the pathophysiology of POVL is often incompletely understood. Disability from POVL can range from transient blurring or loss of vision to devastating, permanent bilateral blindness.
This topic will discuss the types of postoperative visual disturbances, what is known about etiology, and recommendations for prevention and treatment as they relate to anesthesia care. Acute visual loss in other settings is discussed separately. (See "Approach to the adult with acute persistent visual loss" and "Approach to acute vision loss in children" and "Optic neuropathies".)
The exact incidence of postoperative visual loss (POVL) is unknown. POVL is a rare complication of surgery, with increased prevalence after cardiac, spine, head and neck, and some orthopedic procedures. Data come largely from retrospective studies and case series.
Estimates of the rate of POVL by type of surgery from a large national database were as follows :
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- URGENT EVALUATION OF VISUAL LOSS
- MOST COMMON CAUSES
- Corneal abrasion
- - Etiology
- - Diagnosis
- - Management
- - Prevention
- Postoperative ischemic optic neuropathy
- - Postoperative anterior ION
- - Postoperative posterior ION
- Risk factors
- - ION associated with spine surgery
- - Strategies for prone spine surgery
- Cerebral visual loss
- - Incidence and etiology
- - Diagnosis and management
- - Prevention
- Central retinal artery occlusion
- - Etiology
- - Diagnosis and management
- - Prevention
- - Branch retinal artery occlusion
- LESS COMMON CAUSES
- Acute angle-closure glaucoma
- Retrobulbar hematoma
- Pituitary apoplexy
- Glycine-induced visual loss
- Posterior reversible encephalopathy syndrome
- SUMMARY AND RECOMMENDATIONS