Visual Loss After Intraoral Local Anesthesia for the Removal of Circumzygomatic and Circum-Mandibular Wires: A Case Report

A rare case report of pseudomyopia after impacted teeth extraction under general anesthesia

“…Although most dental anesthesia is performed without severe complications 20 , care should be taken not to inject into the blood vessels. Even with aspiration, however, the needle can be moved during administration or the injection pressure can cause anesthesia to flow back through the arteries 5 .…”

“…These authors suggested the possibility of an anesthetic solution spreading through the blood vessels. In some review articles, a mechanism was suggested in that the anesthetic solution could have been injected into the arteries or veins, causing diplopia due to ophthalmoplegia, visual loss due to ischemic optic neuropathies, and tonic pupil 4 , 5 . Ischemic optic neuropathies can lead to permanent visual loss due to optic atrophy and can be diagnosed by the clinical findings of optic disc edema, afferent pupillary defect, and crowded small optic nerve head or by fat-suppressed contrast-enhanced magnetic resonance imaging (MRI) findings of compressive optic neuropathy or inflammatory optic neuritis 6 .…”

Unilateral Vision Loss after a Dental Visit

“…Epinephrine that reaches the orbit can induce vasoconstriction of the ophthalmic or ciliary arteries. Furthermore, cilioretinal arteries are more vulnerable to vasoconstriction by epinephrine than are ophthalmic arteries, because of their smaller diameter compared to the central retinal artery [ 9 ]. On the other hand, neurotoxicity has been reported as a side effect of articaine, caused by neural ischemia due to the vasoconstriction induced by articaine itself or by epinephrine [ 10 ].…”