Rethinking anaesthesia strategies for patients with traumatic eye injuries: Alternatives to general anaesthesia

Regional anaesthesia has traditionally been considered to be contraindicated in patients with traumatic eye injuries, in part owing to the potential to extrude intraocular contents via force generated by local anaesthetics. Needle instrumentation of the orbit, squeezing of the eyelids, and pressure due to bleeding are additional reasons regional anaesthesia is typically avoided in open-globe scenarios. Nonetheless, anecdotal case reports and subsequent retrospective and prospective series of successful use of ophthalmic blocks in this setting have been published. In an 8-year period, over 450 traumatic eye injury cases were reviewed at the University of Miami's Miller School of Medicine Bascom Palmer Eye Institute. A significant number of injuries were repaired under regional anaesthesia techniques. Successfully blocked eyes tended to have more anterior, smaller wounds than those repaired via general anaesthesia. There was no difference in outcome, defined as comparative change of visual acuity from initial evaluation until final examination, between the eyes repaired via regional vs. general anaesthesia. A prospective study of selected open-globe patients found similar results. Moreover, combined topical anaesthesia and sedation for selected patients with open-globe injuries has also been reported.