Korean J Ophthalmol.  2006 Jun;20(2):139-142. 10.3341/kjo.2006.20.2.139.

Visual Loss in One Eye after Spinal Surgery

• Chung MS
• Son JH

• KMID: 1099051
• DOI: http://doi.org/10.3341/kjo.2006.20.2.139

Abstract

PURPOSE: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. METHODS: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. RESULTS: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. CONCLUSIONS: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.

Keyword

Central retinal artery occlusion; Ophthalmoplegia; Prone position; Spinal surgery

MeSH Terms

Visual Acuity
Severity of Illness Index
Retinal Artery Occlusion/*complications/diagnosis
Postoperative Complications
Ophthalmoplegia/*complications/diagnosis
Neck Injuries/diagnosis/*surgery
Middle Aged
Male
Magnetic Resonance Imaging
Laminectomy/*adverse effects
Humans
Fundus Oculi
Follow-Up Studies
Fluorescein Angiography
Diagnosis, Differential
Cervical Vertebrae/injuries/*surgery
Blindness/*etiology

Figure

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  Fig. 1 Ocular fundus photography on the second postoperative day. The right eye shows a pale optic disc with an edematous retina and a cherry-red spot on the fovea.

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  Fig. 2 Fluorescein angiogram on the second postoperative day. The right eye shows an extreme delay in arterial filling time.

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  Fig. 3 T2-weighted image of orbital MRI shows mild periorbital swelling and edema of the extraocular muscles in the right eye, with the tendons spared.

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  Fig. 4 Ocular fundus photography after three months. The right eye shows optic atrophy.

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