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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Can an eye stroke be caused as a result of trauma to the optic

Resolved Question:

Can an eye stroke be caused as a result of trauma to the optic nerve during cataract surgery?
Submitted: 2 years ago.
Category: Eye
Expert:  Dr. Rick replied 2 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

Cataract surgery usually does not involve the optic nerve or any eye structures behind the lens. It would be very unlikely that a vein or artery occlusion (stroke of the eye) was caused by the surgery.

Dr. Rick :

This would be especially true if the "no shot" technique of ocular anesthesia was used, as is the common practice in cataract surgery today.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Please remember the top 3 ratings are positives [Excellent service is my goal] and this is how we are compensated. Rate my answer when you are satisfied. If you feel the need to rate low, please stop and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.


Otherwise, a high positive rating is very much appreciated, bonuses are great, and find me anytime for follow up.


 


Let me know if you have further questions.

Dr. Rick :

I see that you are offline. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Expert:  Dr. Rick replied 2 years ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

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If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Customer: replied 2 years ago.
The reason I asked this questions was because during surgery the Dr. commented I am having trouble sticking the lense...he said it twice. Then he finally said "I got it". My first eye took 25 minutes for cataract surgery and my right eye took 1 1/2 hours for the same surgery. My patch had blood on it and the next day when the Dr. removed my patch I could see that my eye had bled. Hence, trauma happened during my surgery.
Expert:  Dr. Rick replied 2 years ago.
It does sound like your surgeon had a difficult time with part of your cataract surgery. Sometimes the intraocular lens doesn't want to go into the capsular bag like it is supposed to and you have to "fight" with it a bit -- which from what you have posted, seems like was happening in your case. This activity goes on in the front part of your eye, a very long way away from your optic nerve and retina.

It is also not unusual to have a bit of blood on the eye patch the next day especially if your surgeon used the conjunctival approach for your surgery instead of clear cornea. You just had surgery so some bleeding is not unusual :)

As a retina specialist with two decades of experience dealing with "eye strokes" I am confident, from what you have told me about your difficult cataract surgery, that this was not the cause of your "eye stroke"

Does this make sense to you?

It was a pleasure to be able to help you today. If you would be so kind, please help me get credit for my efforts in answering your questions and press the excellent feedback button for this encounter. I would also be happy to continue to answer any more questions you have until we have resolved your concern.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Customer: replied 2 years ago.

Do I understand correctly that if a shot technique of ocular anesthesia was used, the eye could have suffered some kind of trauma or possibly have caused the eye stroke?

Expert:  Dr. Rick replied 2 years ago.
Yes it is possible although very rare, on the order of about one half of one percent chance.... This could occur if the needle was to actually strike the optic nerve or pierced the eyeball.

In the vast majority of cases where this (rarely) occurs the error would be quickly noticed and, in any event, physical evidence would be obvious on examination.

Does this make sense?
Customer: replied 2 years ago.

The hospital report states that garamycin and celestone were injected into subconjunctival; therefore, the shot technique was used during surgery. Therefore, is it safe to conclude that the optic nerve received trauma?

Expert:  Dr. Rick replied 2 years ago.
No. The injection of the garamycin and celestone are medicines given by a superficial injection under the "skin" of the eye. This would not damage the optic nerve in any way.

The injection technique I am referring to is called retrobulbar anesthesia. This is where the numbing medicine is placed behind your eyeball to keep you pain free and your eye from moving during cataract surgery. Here is how retrobulbar anesthesia works (the optic nerve is coming out of the middle of the globe):

http://images.search.yahoo.com/images/view;_ylt=A0PDoQ6c9fRPLyQALW2JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3F_adv_prop%3Dimage%26va%3Dretrobulbar%2Binjection%26fr%3Dyfp-t-701-s%26tab%3Dorganic%26ri%3D1&w=432&h=317&imgurl=catalog .nucleusinc.com%2Fimagescooked%2F15612W.jpg&rurl=http%3A%2F%2Fcatalog.nucleusinc.com%2Fgenerateexhibit.php%3FID%3D15612&size=32.4+KB&name=Retrobulbar+Injection+-+Medical+Illustration%2C+Human+Anatomy+Drawing+...&p=retrobulbar+injection&oid=264dee5ce38241624b859ee14c0d6c70&fr2=&fr=yfp-t-701-s&tt=Retrobulbar%2BInjection%2B-%2BMedical%2BIllustration%252C%2BHuman%2BAnatomy%2BDrawing%2B...&b=0&ni=200&no=1&ts=&tab=organic&sigr=11q3e30bg&sigb=13l0l0h9m&sigi=11ekuamr6&.crumb=rQIQKwemEPU

The vast majority of cataract surgeons no longer use retrobulbar anesthesia but rather use topical and intracameral (inside the eye) infusion. I would bet that your surgeon used topical anesthesia in which case trauma to the optic nerve or retina would be impossible.

I hope this helps....
Customer: replied 2 years ago.
What does it mean that intravenous sedation was used and during this time a retrobulbar block and facial block were done? Also, day after surgery the Dr. did not tell me I had dried blood behind the eye; however, the patch did show blood. I saw a nerve Dr. three days later and this Dr. told me that I had dried blood behind the eye and the optic nerve was swollen. Also, a MRI was done and the Dr. said it was negative for any stroke, etc. So, what could have happened to the optic nerve since the MRI did not reflect any problems with the eye?
Expert:  Dr. Rick replied 2 years ago.
That means you were given some "happy juice" so that the pain of the retrobulbar and modified van lint or nadbeth block didn't bother you.

You had the type of anesthesia that was outlined by the picture I gave you.....

The blood on the patch would not have come from behind the eye; most likely it came from the conjunctiva where you were given the garamycin and celestone.

As to what happened to the optic nerve, that is an excellent question. The only way to be 100% sure would have been to directly look at the nerve by opening up your orbit -- not something that would ever be done.

Could your optic nerve have been impacted by the retrobulbar injection? Yes. What is the chance of that? About 0.05% -- a very small, but real, chance.

What is your goal in this discovery?

Please remember the top 3 ratings are positives [Excellent service is my goal] and this is how we are compensated. Rate my answer when you are satisfied. If you feel the need to rate low, please stop and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.

Otherwise, a high positive rating is very much appreciated, bonuses are great, and find me anytime for follow up.

Let me know if you have further questions.

Customer: replied 2 years ago.
What type of medicine should be taken for the swelling of the optic nerve? What time frame am I facing before the optic nerve returns to normal?
Expert:  Dr. Rick replied 2 years ago.
There is really no specific treatment for swelling of the optic nerve, other then to treat any systemic underlying pathology. In your case, I do not believe that there is any systemic issues causing your optic nerve swelling.

What ever function you have after about 6 months will be about what you will have forever.

Does this make sense to you?
Customer: replied 2 years ago.
I went to see another opthalmologist. He advised me that my optic nerve was not swollen any more. If that's the case, why do I still have vision problems with my right eye...does that mean I have suffered permanent damage to my optic nerve?

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