Atraumatic extraction was done of right first maxillary molar with buccal infiltration and greater palatine nerve block (lignocaine 2%with adrenaline 1:80,000). The patient complains of blurred vision and pain in the lacrimal gland area of their right side. Pupil reflexes are normal, as is the healing of the socket.
First of all, was the patient referred to the ophthalmologist to check what was the reason for blurred vision. When the patient complains on blurred vision and pain ? immediately or latter. In my opinion the reason for meantioned abnormalities was local anesthesia into second branch of trigeminal nerve spreaded into first - ophthalmic branch , causing pain in lacrimal gland area due to lacrimal nerve - V1
Patient felt pain and blurred vision next morning after 20 hours of extraction.
And yes patient is referred to ophthalmologist . waiting for diagnosis.
The possible cause for blurred vision could be optic neuropathy- anteriot or posterior due to local anestethic or retinal artery occlusion due to adrenalin
For proper management we need to know more details about this patient -age, general health, systemic hypertension or diabetes, etc. and also the most important - the findings from ophthalmologist. I 'l try to help, but I am not able to recommend anything without whole information.
Marianne can you please elaborate how can LA given to extracted right maxillary first molar when infiltration given in buccal vestibule of right first molar and greater palatine nerve block with negative aspiration can reach retinal artery or can cause optic neuropathy. I am still waiting for the reports from ophthalmologist. will update soon with all the medical history of the patient.
In my opinion adrenaline could cause arteriolar constriction, since maxillary bone forms the floor of orbit and the eyeball is in neiborehood.
I have my personal experience about patient after open cardial surgery -shunt developed in both eyes on the second post-op day anterior ischemic optic neuropathy.
The second option is that after V 2 block LA penetrates spreading into V1.
Dear karanpal,i understand your concern,this is really a rare condition and uncommon,what is the age of the patient,is she/he a diabetic or hypertensive?did the patient have any problem during the procedure? Did she complain of anything unusual during or after the procedure.sit quietly and think and visualise the entire situation,youll find the answer.it is not just right molar ,it is all connected many times and in many ways,we already understand & in many ways,
yet to understand.
Dear Doctor Karanpal Singh Mann ,
Have you updated information about your patient ?
hello Marianne, sorry i was not able to reply. I tried to contact patient but there is no response from his side. Age of the patient is 50 years. No history of hypertension or diabetes. Extraction was normal and atraumatic, healing was perfect postoperative day.
I suppose if the patient does not response his ocular problems resolved with time - which is the best doctor, of course in some cases. Wishing you continued fruiful and unevenful work.
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