Table 1 Perioperative loss of vision in nonocular surgery – common differential diagnoses[15–17]
Site of injury/location of the lesion causing visual problems | Specific location | Underlying causes |
|---|---|---|
External ocular injury | Corneal abrasion, corneal exposure | Perioperative exposure of cornea or microtrauma |
Retina (retinal ischemia) | Central retinal artery occlusion/occlusion of retinal arterial branch either ischemic or embolic | Occurs mainly in cardiac/vascular surgeries (emboli), but also in spinal surgery due to prone positioning (external compression of the globe), very rarely other forms of surgery (e.g. orthopedic surgery) |
Purtscher’s can be regarded as a special form of this entity | ||
Ischemic optic neuropathy | Anterior ischemic optic neuropathy, posterior optic neuropthay | Most common site of permanent injury, most often in spinal surgery (prone position), bilateral involvement in most cases |
Lesion of retrochiasmal visual pathways | Either homonymous hemianopia (unilateral) or cerebral/cortical visual impairment (bilateral) | Most common mechanism: embolic cerebral infarction (posterior cerebral arteries). Mainly in cardiac surgeries, resection of head and neck tumors |