Endophthalmitis nach enoraler Blockade des Nervus infraorbitalis

Summary

Background Most penetrating needle puncture injuries occur in retro- or peribulbar anesthesia. Hereby only a small percentage of patients develop endophthalmitis. Ocular penetration after enoral infraorbital nerve block has not yet been reported in literature.

History and findingsIn June 1995 a 74-year-old man presented with a fulminant fibrinous and purulent endophthalmitis. Because he suffers from trigeminal neuralgia his anesthesiologist performed an infraorbital nerve block from enoral two days ago. During this procedure the patient felt a sharp ocular pain.

Therapy and outcome We suspected an ocular penetration and performed a vitrectomy with intravitreal antibiotic instillation on the admission-day. A needle penetration site near the inferior rectus muscle was detected and after exocryocoagulation a 5 mm wide radial buckle was sutured over penetration site. Three months postoperatively vision recovered from hand moving to 20/50 and all infiltrations had been disappeared. Only preexisting cataract prevented a better vision. 10 months later after succesful cataract extraction with intraocular lens implantation patient left hospital with a vision of 20/30.

Conclusion Careful anamnesis would have prevented this accidental globe penetration. Right upper palate is absent presumably due to congenital cleft malformation or surgery. This allowed needle penetration through smooth tissue into the right globe. Fortunately, endophthalmitis develops only in a small percentage after needle puncture. We recommend immediate pars-plana-vitrectomy and intravitreal antibiotics in case of endophthalmitis after ocular penetration.

Key words

endophthalmitis - penetrating injury - pars-plana-vitrectomy - intravitreal antibiotics - nerve block

Schlüsselwörter

Endophthalmitis - penetrierende Verletzung - Vitrektomie - intravitreale Antibiotika - Leitungsanästhesie