[Ocular complications of local anaesthesia in dentistry]. / Oculaire bijwerkingen van lokale anesthesie in de tandheelkunde.

An estimated 1 in 1,000 local anaesthetic injections in the maxilla or the mandible lead to unwanted effects on the ipsilateral eye. We have seen a case with diplopia and lateral rectus palsy following bimaxillary anaesthesia. A systematic literature review of reports on this type of complication resulted in a total of 144 documented cases published between 1936 and 2016. The most frequently reported symptoms included diplopia (72%), partial or full ophthalmoplegia (26%), ptosis (22%), mydriasis (18%), amaurosis (13%) and orbital pain (12%). This type of complication is best understood by pathophysiological hypotheses that include intra-arterial injection, intravenous injection, autonomic dysregulation, or deep injection and diffusion. If ocular symptoms appear after local intraoral anaesthesia, the patient should be reassured. In the case of diplopia, the eye should be covered with a gauze dressing, and the patient should be instructed about associated safety risks. If symptoms persist or when vision deteriorates, referral to an ophthalmologist is advisable.

Transient ipsilateral mydriasis during correction of left blowout fracture.

Mydriasis, either bilateral or unilateral, seldom occurs during reconstruction of periorbital fracture. Anisocoria, a unilateral mydriasis, requires more urgent assessment than bilateral mydriasis does. Pharmacologic agents, local anesthetic infiltration, as well as direct or indirect oculomotor nerve damage are possible causes of unilateral mydriasis. Few cases have been reported about intraoperative temporary ipsilateral mydriasis during correction of blowout fracture. We have experienced an unusual case of anisocoria and report the case with literature reviews.

Unilateral mydriasis potentially associated with contact with a supplement powder mix.

INTRODUCTION: Dietary supplement use is common in military populations. Presented is a case of unilateral mydriasis from contact with a supplement mix. Standardized approach to mydriasis is fundamental for diagnosis. CASE: A 20-year-old active duty Marine presented to the Emergency Department for evaluation of an enlarged pupil. She had no visual deficits or symptoms otherwise. She had been consuming increased amounts of energy drinks including a supplement powder mix and recalled rubbing her eye while pouring the mix that morning. Her exam demonstrated an asymmetric, nonreactive right pupil both directly and consensually with normal left pupil findings. Exam was otherwise unremarkable. Following unresponsiveness to pilocarpine challenges, pharmacological dilation was diagnosed potentially, secondary to supplement contact without absolute causative effect established. Two days afterward, her exam was normal. DISCUSSION: Several supplement mixes contain compounds with stimulant activity mimicking medications used for pupil dilation. Unilateral mydriasis from contact with anticholingeric substances has been reported, specifically Angel's Trumpet, ipratropium, and moonflower, but there have been no reports with supplement mix-induced dilation. CONCLUSION: Dietary supplement use in the military is an overwhelming phenomenon. This unique presentation of pharmacological mydriasis reinforces the importance of supplement histories in our military populations for various health presentations.

A case of unilateral mydriasis secondary to septoplasty under local anaesthesia.

Septoplasty is a procedure performed to correct deformities of the nasal septum. Serious complications associated with septoplasty include orbital complications. Here, we present a 26-year-old male patient who developed unilateral mydriasis while undergoing septoplasty under local anaesthesia. The mydriasis resolved spontaneously in an hour without any sequel. In the present study, we emphasise the orbital complications that can be observed during septoplasty.

[Non-hypothermic J wave in subarachnoid hemorrhage]. / Onda J no hipotérmica en hemorragia subaracnoidea.

Incidence of electrocardiographic abnormalities in subarachnoid hemorrhage secondary to aneurysm rupture is 50-100%. The most frequent electrocardiographic abnormalities described include acuminated, inverted or flat T waves, inverted T waves associated with prolonged QT interval, positive or negative ST segment levels, prominent U waves, PR segment enlargement, acuminated P waves, and pathologic Q waves. J point is the isoelectric union of QRS complex with ST segment. It represents the end of depolarization and the beginning of repolarization. Prominent and positive J point level is named J wave, considered pathognomonic of severe hypothermia, although it has also been described in other clinical entities not associated with hypothermia, such as hypercalcemia, Brugada syndrome, acute brain injury, cardiac arrest, and dysfunction of cervical sympathetic system. Non-hypothermic J wave is an infrequent electrocardiographic manifestation of subarachnoid hemorrhage. We describe a clinical case of non-hypothermic J wave in a patient with subarachnoid hemorrhage.

Ocular jellyfish stings.

BACKGROUND: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours. METHODS: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years. RESULTS: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases. CONCLUSIONS: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.

Transient internal ophthalmoplegia during blepharoplasty. A report of three cases.

The present paper presents three cases of transient internal ophthalmoplegia during blepharoplasty. All cases were characterized by a dilated pupil that was unreactive to light or an accommodative stimulus. There were no cases of visual loss or permanent pupillary abnormalities. We attribute the temporary pupillary mydriasis and accommodative insufficiency to anesthesia of the short ciliary nerves or ciliary ganglion from local anesthetic diffusing into the orbit at the time of injection. To the best of our knowledge this is a complication of eyelid surgery that has not been previously described.