Ophthalmology in anaesthesia and intensive care

Uncommon ophthalmologic disorders in intensive care unit patients

“…Acute primary angle closure is a sight-threatening emergency caused by sudden elevation of the intraocular pressure (IOP) secondary to pupil block [2,43,44].…”

“…Systemic anticholinergic agents commonly used in ICU such as ipatropium bromide, chlorpromazine bromide, amitriptyline, thioridazine, and cyclizine increase dilatation of the pupil and may precipitate pupillary block [2,[43][44][45][46][47]. Several studies recognized APAC as a complication of parenteral anticholinergic drugs used during general anesthesia [48][49][50].…”

“…In conscious patients, this may be accompanied by severe pain, vomiting, and confusion. If suspected, ophthalmology advice should be sought urgently [43,44]. In addition, use of an ICare-type rebound tonometer (Tiolat Oy, Helsinki, Finland) to measure IOP by ICU staff may be a valuable asset in detecting APAC.…”

“…It occurs in several immunocompromised states that are particularly common in critically ill patients [2,43,86]. It is most prevalent in diabetic patients who are also acidotic (diabetic ketoacidosis), which offers favorable conditions for fungal multiplication [2,86].…”

“…Treatment with amphotericin B alone has a limited role because of impaired delivery to the site of infection as a result of vascular thrombosis [2,86]. Orbital involvement may require aggressive surgical debridement, including orbital exenteration, which can be lifesaving [2,43,86]. Bhansali et al [86] reported a higher survival rate of 68% in patients who received a combination of medical and surgical treatment.…”