[Intraocular ischemic infarcts in injections into the lid and parabulbar region (without perforation of the eye)].

Two outpatients presented with disseminated intraocular ischemic infarctions after injection into the lid and in retrobulbar regions. A 34-year-old patient suffered a sudden and permanent loss of vision due to segmental optic atrophy prior to a chalazion excision under local anesthesia in the right upper and lower lids, with 2 ml Novocain 2%. A 55-year-old patient received parabulbar injections of crystalline cortisone with additional Scandicain 1% in the temporal region of the lower lid. During the injection a sudden complete loss of vision occurred, due to an occlusion of the central retinal artery, resulting in a total simple optic atrophy with complete amaurosis. The disseminated intraocular ischemic infarctions appear to be primarily due to intra-arterial injections, where the ophthalmic artery acts as a "bridge artery" between the extracranial and intracranial circulation. The rise in pressure in the capillaries of the external carotid artery effects a reversal of the circulation, as a result of which embolizing material reaches the ophthalmic artery and its capillaries. It is difficult to decide what role locally admixed vasoconstrictive drugs play in individual cases in which air has accidentally been injected intravasally. Prophylactic measures are discussed.