ABSTRACT
The risks of periorbital anesthetic injections are of some consequence, in that the overall occurrence rate for retrobulbar hemorrhage is in the vicinity of 1 percent of all cases, the likelihood increases with long needles and intraconal injection.2 Furthermore, ocular penetration and optic nerve damage are not terribly rare. The risks of those maloccurrences increase in patients who are uncooperative for injection, those with high myopia, those with prior scleral buckling surgery, and when the injections are administered by non-ophthalmologists. Additionally, no needle types, injection sites, or injection styles are immune to the risk for damage to the globe or other orbital structures.3-5
Another issue regarding the blind passage of sharp needles into the orbit concerns those patients on anticoagulant medications or those with naturally occurring coagulopathies. It should be obvious that these patients are at greater risk for periocular hemorrhage with needle injection, but often the medical necessity for anticoagulation dictates that patients remain on treatment during the perioperative period. Often, the systemic risk to cessation of anticoagulant treatment is greater than the risk of intraoperative bleeding. Indeed, the published guidelines for cataract surgery in the United Kingdom suggest that cataract surgery should proceed up to an INR (International
Normalized Ratio) of 4.0 for patients taking Coumadin. It is evident that non-injection forms of local anesthesia are safer for anticoagulated patients.
