Clinical Review Lesson of the week

Nitrous oxide anaesthesia in the presence of intraocular gas can cause irreversible blindness

BMJ 2002; 325 doi: (Published 07 September 2002) Cite this as: BMJ 2002;325:532
  1. Y F Yang, vitreoretinal fellow (,
  2. L Herbert, vitreoretinal fellowa,
  3. H Rüschen, anaesthetic research fellowb,
  4. R J Cooling, consultant ophthalmic surgeona
  1. Vitreoretinal Department, Moorfields Eye Hospital, London EC1V 2PD,
  2. Anaesthetic Department, Moorfields Eye Hospital
  1. Correspondence to: Y F Yang
  • Accepted 13 February 2002

Retinal detachment arising from a retinal break occurs in about 1 person per 10 000 per year.1 Spontaneous retinal reattachment is rare, and retinal reattachment surgery is required to prevent irreversible total loss of vision. Modern vitreoretinal techniques often use intraocular gases as tamponading agents. These gases may persist in the eye for up to three months after surgery. During this period further anaesthesia using nitrous oxide will cause the intraocular gas bubble to expand,25 which can result in sight threatening increases in intraocular pressure. We present a case in which this occurred with devastating consequences.

Case report

A 71 year old man presented to his local ophthalmology unit with a two month history of poor vision in the left eye. He was found to have a vitreous haemorrhage in this eye and was followed up with serial ultrasound scans. He subsequently developed a left retinal detachment and was referred to the vitreoretinal unit for surgery. On presentation at the unit his best corrected visual acuity was 6/12 in the right eye and 2/60 in the left. He also had glaucoma and used two topical ocular antihypertensive medications. He underwent a vitrectomy procedure with retinal cryotherapy to create an adhesive chorioretinal scar around the retinal break. A mixture of 86% purified air and 14% perfluoropropane gas was injected into the vitreous cavity as a …

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