How safe is a retrobulbar block?

> My surgeon wants to use retrobulbar anesthesia given with a blunt
> needle. He believes that it is very safe and states that he has never
[quoted text clipped - 3 lines]
> more pain and potential damage than sharp ones. Does anyone know
> anything about this?

As an optometrist, I know a little about it. Just got back from
holidays and am surprised your post didn't get answered by now. I guess
this n.g. is worse off than when I left it.

Anyway, retrobulbar anesthesia does have risks, in addition to global
perforation. Why is he doing it? What operation or procedure do you need?

w.stacy, o.d.

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Jane - 04 Jan 2006 02:42 GMT

Thanks for your interest. My choices for vitreoretinal surgery (at
least with my surgeon) are retrobulbar block or general anesthesia
(which I'd certainly rather avoid.) My way of reducing anxiety about
the surgery is to read everything I can about it, but this strategy has
its pitfalls. A number of journal articles report that patients with
high myopia (like me!) have 30 times the risk of global perforation
from retrobulbar injections compared with patients with normal axial
length. The consequences of such perforations are reported to be
catastrophic, but the incidence in high myopics is still only about 1
percent. I don't know what to make of this. Are the catastrophies the
result of injections given by incompetent docs or are they random
events? I was hoping someone might be able to enlighten me?

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William Stacy - 04 Jan 2006 05:42 GMT

> Thanks for your interest. My choices for vitreoretinal surgery (at
> least with my surgeon) are retrobulbar block or general anesthesia
> (which I'd certainly rather avoid.)

I can understand that, since while the former might put your eye at some
risk, the latter is closer to putting your life at risk.

My way of reducing anxiety about

> the surgery is to read everything I can about it, but this strategy has
> its pitfalls. A number of journal articles report that patients with
[quoted text clipped - 3 lines]
> catastrophic, but the incidence in high myopics is still only about 1
> percent.

1% is high, for a catastrophic outcome. But then at -7 you're really
not all that highly myopic (just barely in the category) so your eye is
not really that much "in the way".

I don't know what to make of this. Are the catastrophies the

> result of injections given by incompetent docs or are they random
> events? I was hoping someone might be able to enlighten me?

I'd say yes and yes. Choose your surgeon well, and say a little prayer.

I'd like to give more definitive info to you, but I'm an o.d. who
doesn't do surgery. I've had a couple though, and am a big believer in
getting generous sedation with loads of local anesthetic. Don't much
care for pain. I've done a bit of research tonight and must say I'd
probably lean toward the local as long as I'm far enough out of it to
not care about the "infusion". Anyway, if you're going to a class act
vitreoretinal surgeon, I'd follow his/her advice and git 'er done.

w.stacy, o.d.

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Ann - 07 Jan 2006 19:13 GMT

>Thanks for your interest. My choices for vitreoretinal surgery (at
>least with my surgeon) are retrobulbar block or general anesthesia
[quoted text clipped - 8 lines]
>result of injections given by incompetent docs or are they random
>events? I was hoping someone might be able to enlighten me?

Retrobulbar block is rarely done in the UK nowadays because of the
high incidence of complications. It has been replaced by and large by
the peribulbar block. The success of either is dependent on the skill
of the doctor.

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Retrobulbar's were once routinely used for cataract surgery, now only used
for a few cases. We have never had an instance of global perforation.
Sometimes patients report double vision (the block paralyzes muscles), but
it goes away. Patients leave the hospital with an eye patch because they
are unable to blink completely due to the block as well, and usually end up
with a nice shiner. As far as blunt needle vs. sharp... I don't know if it
is even done with a sharp needle. (I work mainly in the office.) You will
likely be given something before the retro block to relax you. I don't
recall patients ever complaining about the pain of the injection. I have
observed my ophthalmologist giving this block a few times, the patient
didn't appear to be in any great distress.

The risks reported in journal articles - you'd have to read where they got
their information to know where the incidents occurred and by whom.

> My surgeon wants to use retrobulbar anesthesia given with a blunt
> needle. He believes that it is very safe and states that he has never
[quoted text clipped - 3 lines]
> more pain and potential damage than sharp ones. Does anyone know
> anything about this?

Reply to this Message

Retrobulbar's were once routinely used for cataract surgery, now only used
for a few cases. We have never had an instance of global perforation.
Sometimes patients report double vision (the block paralyzes muscles), but
it goes away. Patients leave the hospital with an eye patch because they
are unable to blink completely due to the block as well, and usually end up
with a nice shiner. As far as blunt needle vs. sharp... I don't know if it
is even done with a sharp needle. (I work mainly in the office.) You will
likely be given something before the retro block to relax you. I don't
recall patients ever complaining about the pain of the injection. I have
observed my ophthalmologist giving this block a few times, the patient
didn't appear to be in any great distress.

The risks reported in journal articles - you'd have to read where they got
their information to know where the incidents occurred and by whom.

> My surgeon wants to use retrobulbar anesthesia given with a blunt
> needle. He believes that it is very safe and states that he has never
[quoted text clipped - 3 lines]
> more pain and potential damage than sharp ones. Does anyone know
> anything about this?

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