Limits...
The management of gas-filled eyes in the emergency department.

Lim LT, Ah-Kee EY, House BP, Walker JD - Case Rep Emerg Med (2014)

Bottom Line: There are specific management guidelines that need to be followed to ensure surgical success, and there are also unique ophthalmic and systemic complications that can occur in such patients.Objective.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK.

ABSTRACT
Background. Intraocular gas bubbles are commonly used in retinal surgery. There are specific management guidelines that need to be followed to ensure surgical success, and there are also unique ophthalmic and systemic complications that can occur in such patients. Objective. To educate emergency department personnel about important issues in the management of patients who have a gas-filled eye following retinal surgery. Case Report. A patient with a gas-filled eye developed several complications including pain, severe vision loss, high-grade atrioventricular (AV) block, and pneumocephalus. Conclusion. Awareness of potential problems that may arise in patients with gas-filled eyes who present to the emergency department may help minimize morbidity for such patients.

No MeSH data available.


Related in: MedlinePlus

CT scan showing gas in the left eye and optic nerve (a) and intracranial air adjacent to the basal ganglia (b).
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fig1: CT scan showing gas in the left eye and optic nerve (a) and intracranial air adjacent to the basal ganglia (b).

Mentions: Her retinal surgeon was not informed of these events and she was ultimately seen again on postoperative day five. On that visit her anterior chamber was flat. (The iris and her intraocular lens had been pushed forward against the back of the cornea. This was an indication that the gas bubble had significantly expanded or she had been positioning improperly, with the bubble pushing up against the front of the eye rather than back toward the macular hole.) The pressure in the eye was markedly elevated to 88 (normal being up to 21). The ophthalmologist lowered the pressure to the normal range by withdrawing gas from the vitreous cavity. Later that day the patient developed acute mental status changes and again presented to the ED. A computed tomography (CT) scan demonstrated intracranial air in addition to the gas bubble in the eye (Figure 1). She was referred to a tertiary care center where it was opined that the intraocular gas bubble had expanded and tracked along the optic nerve, eventually entering the brain. This was likely due to the use of an expansile gas concentration during the surgery. The intracranial air gradually resolved, as did her mental status changes, but the involved eye lost all vision due to high pressure maintained over an extended period of time.


The management of gas-filled eyes in the emergency department.

Lim LT, Ah-Kee EY, House BP, Walker JD - Case Rep Emerg Med (2014)

CT scan showing gas in the left eye and optic nerve (a) and intracranial air adjacent to the basal ganglia (b).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265529&req=5

fig1: CT scan showing gas in the left eye and optic nerve (a) and intracranial air adjacent to the basal ganglia (b).
Mentions: Her retinal surgeon was not informed of these events and she was ultimately seen again on postoperative day five. On that visit her anterior chamber was flat. (The iris and her intraocular lens had been pushed forward against the back of the cornea. This was an indication that the gas bubble had significantly expanded or she had been positioning improperly, with the bubble pushing up against the front of the eye rather than back toward the macular hole.) The pressure in the eye was markedly elevated to 88 (normal being up to 21). The ophthalmologist lowered the pressure to the normal range by withdrawing gas from the vitreous cavity. Later that day the patient developed acute mental status changes and again presented to the ED. A computed tomography (CT) scan demonstrated intracranial air in addition to the gas bubble in the eye (Figure 1). She was referred to a tertiary care center where it was opined that the intraocular gas bubble had expanded and tracked along the optic nerve, eventually entering the brain. This was likely due to the use of an expansile gas concentration during the surgery. The intracranial air gradually resolved, as did her mental status changes, but the involved eye lost all vision due to high pressure maintained over an extended period of time.

Bottom Line: There are specific management guidelines that need to be followed to ensure surgical success, and there are also unique ophthalmic and systemic complications that can occur in such patients.Objective.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK.

ABSTRACT
Background. Intraocular gas bubbles are commonly used in retinal surgery. There are specific management guidelines that need to be followed to ensure surgical success, and there are also unique ophthalmic and systemic complications that can occur in such patients. Objective. To educate emergency department personnel about important issues in the management of patients who have a gas-filled eye following retinal surgery. Case Report. A patient with a gas-filled eye developed several complications including pain, severe vision loss, high-grade atrioventricular (AV) block, and pneumocephalus. Conclusion. Awareness of potential problems that may arise in patients with gas-filled eyes who present to the emergency department may help minimize morbidity for such patients.

No MeSH data available.


Related in: MedlinePlus