Relapsing Optic Neuropathy Followed by Optic Nerve Injury after Peribulbar Anesthesia – A Case Report

Purpose: To present a case with adrenal insufficiency with relapsing visual deterioration due to optic nerve Injury after peribulbar anesthesia.
Methods: A case report.
Results: A 74-year-old man with adrenal insufficiency underwent cataract surgery of his left eye under peribulbar anesthesia. The best-corrected visual acuity (BCVA) of his left eye before the surgery was 20/125. During anesthesia, optic nerve injury by needle was noted. His bare visual was 20/125 with normal intraocular findings on the first postoperative day. However, BCVA of his left eye decreased to hand motion at 15cm of his left eye on the postoperative day 3 without obvious relative afferent pupillary defect. He was admitted for methylprednisolone intravenous injection therapy for 3 days. BCVA of his left eye recovered to 20/400 after the therapy. However, 2 days later, his visual acuity was downhill below 20/400 and he was admitted for steroids therapy again. BCVA of his left eye was stable around 20/30 after 4 months followup.
Conclusion: The prognosis of partial optic nerve injury is relatively good. Steroids therapy or replacement treatment for patient with adrenal insufficiency for ophthalmic surgery under local anesthesia could be considered under some condition (such as after an eventful surgery) or we should discuss with his/her internist before starting the treatment.