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Loss of vision following a dental procedure- a case study

| Posted in: Science

Journal name: World Journal of Pharmaceutical Research
Original article title: Loss of vision following a dental procedure- a case study
The WJPR includes peer-reviewed publications such as scientific research papers, reports, review articles, company news, thesis reports and case studies in areas of Biology, Pharmaceutical industries and Chemical technology while incorporating ancient fields of knowledge such combining Ayurveda with scientific data.
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Original source:

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Author:

Mridula V. Amarnath


World Journal of Pharmaceutical Research:

(An ISO 9001:2015 Certified International Journal)

Full text available for: Loss of vision following a dental procedure- a case study

Source type: An International Peer Reviewed Journal for Pharmaceutical and Medical and Scientific Research

Doi: 10.20959/wjpr201913-16240

Copyright (license): WJPR: All rights reserved


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Summary of article contents:

Introduction

Intraoral local anaesthesia is commonly employed in dental procedures but carries the risk of ocular complications. Although such complications are generally rare and mild, they can lead to serious conditions such as reduced vision or even blindness. This case study outlines a rare occurrence of vision loss in a 30-year-old female patient following a dental procedure where intraoral local anaesthesia was administered. The study investigates the potential causes and mechanisms behind her sudden vision deterioration and discusses important considerations for dental practitioners.

Intravascular Injection of Epinephrine and Ocular Complications

One significant aspect arising from this case is the potential impact of intravascular injection of epinephrine during dental procedures. Epinephrine is commonly used alongside local anaesthetics to prolong their effect and provide a bloodless surgical field through vasoconstriction. In this instance, the patient developed symptoms of reduced vision and headache shortly after receiving combined lignocaine hydrochloride and epinephrine. The study posits that the inadvertent injection of epinephrine may have resulted in vasoconstriction of the cilioretinal artery, leading to a cilioretinal artery occlusion and consequent loss of vision.

Diagnosing Cilioretinal Artery Occlusion

The diagnosis of cilioretinal artery occlusion was confirmed through ocular examinations, including visual acuity assessments, fundus examinations, and optical coherence tomography (OCT). Findings indicated swelling of the optic disc, relative afferent pupillary defect in the affected eye, and hypo perfusion in retinal capillaries. These diagnostic measures were crucial for understanding the mechanism of vision loss, highlighting the vital role of detailed ocular evaluation in cases presenting with visual disturbances following dental procedures.

Management and Recovery

Following diagnosis, the patient was started on aspirin as a prophylactic measure for improvement of her condition. Importantly, the patient showed significant visual recovery within four weeks, restoring her vision to 20/20. The ability to trace this swift recovery to timely medical intervention demonstrates the importance of prompt diagnosis and appropriate management strategies in ocular complications linked with dental local anaesthesia.

Conclusion

This case underscores the critical need for dental practitioners to be aware of the risks associated with intraoral local anaesthesia, particularly concerning the use of epinephrine. The occurrence of ocular complications, while rare, emphasizes the necessity for precautionary measures such as aspirating before injection and monitoring patients for any signs of visual disturbances post-procedure. Awareness and education regarding these potential complications can help in reducing the incidence of such adverse events and ensuring patient safety.

FAQ section (important questions/answers):

What was the patient's condition after the dental procedure?

The 30-year-old female patient experienced reduced vision in her left eye a week after undergoing a dental procedure using intraoral local anaesthesia.

What caused the patient's loss of vision?

The probable cause was cilioretinal artery occlusion due to intravascular injection of epinephrine during the dental procedure.

How did the patient's vision change over time?

After initial deterioration, the patient’s vision improved to 20/20 by her follow-up appointment four weeks later.

What kind of local anaesthesia was administered to the patient?

The patient received lignocaine hydrochloride with epinephrine in a 1:100,000 concentration for her dental procedure.

What important precaution should clinicians take during local anaesthesia?

Clinicians should aspirate before injection and administer small quantities while moving the needle to minimize complications.

What are some potential ocular complications of intraoral local anaesthesia?

Complications can include ptosis, diplopia, amaurosis, and various forms of visual impairment.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Loss of vision following a dental procedure- a case study�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Study (Studying):
The term 'Study' signifies the systematic investigation conducted to understand a specific aspect of health or practice. In this context, it refers to the detailed examination and documentation of a rare case of vision loss following dental anesthesia. Such studies contribute to medical knowledge and help improve patient safety protocols.

2) Developing:
The term 'Developing' refers to the process of progression or change. In the context of the case report, it describes the gradual onset of visual deterioration in the patient after the dental procedure. Understanding the development of symptoms is crucial for diagnosing potential complications from medical interventions.

3) Field:
The term 'Field' can refer to a specific area of practice or discipline. In this paper, it refers to dental practice where local anesthesia is commonly used. This field is critical for pain management in dentistry, thus highlighting the importance of understanding its potential complications, particularly in sensitive regions like the eye.

4) Blood:
The term 'Blood' is pivotal in understanding circulation and vascular health. In the context of the case study, it relates to the circulatory mechanisms affected by the use of epinephrine in local anesthesia. Proper blood flow is essential for ocular health, and complications can lead to serious visual impairments.

5) Karnataka:
Karnataka is a state in India where the case study was conducted at Chinmaya Mission Hospital in Bangalore. Its significance lies in establishing the geographical context of the study. The location can influence patient demographics and prevalence of certain health issues, thus adding relevance to the case.

6) Blindness:
The term 'Blindness' represents a significant medical condition involving loss of vision. In the case, it underscores the seriousness of complications that can arise from dental procedures using local anesthesia. Although the studied patient did not experience permanent blindness, understanding such risks raises awareness among healthcare providers.

7) Relative:
The term 'Relative' in this context pertains to a relative afferent pupillary defect observed during the examination, indicating a potential problem in the affected eye's processing of light. It is crucial for understanding the severity of visual impairment and aids in diagnosing the effects of the complications related to anesthesia.

8) Cotton:
The term 'Cotton' refers to 'cotton wool spots,' which appeared during the fundus examination of the patient's eye. These spots are indicators of retinal issues and can signal poor blood flow or damage. Their presence helps in assessing the severity and underlying causes of the patient’s visual symptoms.

9) Wool:
In this context, 'Wool' refers to 'cotton wool spots,' which are small, fluffy white patches on the retina. These are considered crucial findings during ocular examinations and suggest retinal ischemia or other vascular concerns. Identifying such features highlights the need for thorough assessments in patients exhibiting vision changes.

10) Post:
The term 'Post' signifies timing, particularly relating to events occurring after a specific incident—in this case, following the administration of local anesthesia. Understanding the timeline of symptoms arising 'post' procedure is essential for determining causality and providing adequate medical responses to complications experienced by patients.

11) Drug:
The term 'Drug' refers to any substance used for medical treatment—in this case, local anesthetics like lignocaine and epinephrine. Understanding how these drugs act, their potential complications, and the pharmacodynamics involved is vital for dental practitioners to minimize risks during procedures like the one outlined in the case.

12) Accumulation (Accumulate, Accumulating):
The term 'Accumulation' concerns the gathering of substances—in this case, referring to the potential pooling of epinephrine during injection. This concept is important as it raises awareness about best practices in injection techniques, helping to prevent complications like vasospasm or arterial occlusion that may lead to impaired vision.

13) Inflammation:
The term 'Inflammation' represents the body's response to injury or infection. In the context of this case, its absence helps to confirm that the visual symptoms were likely due to ischemic processes rather than inflammatory ones. Careful examination of inflammation signs assists in differentiating the underlying causes of ocular problems.

14) Discussion:
The term 'Discussion' indicates a part of the study where findings are interpreted and placed in context with existing literature. This section is crucial for sharing insights, refining understanding of the complications related to anesthesia, and outlining the need for ongoing awareness and education within dental practices.

15) Swelling:
The term 'Swelling' relates to the observable enlargement in the optic disc found during the examination. This clinical finding can be indicative of increased intraocular pressure or vascular issues. Recognizing such manifestations is important for assessing the effects of complications and guiding further evaluation and treatment strategies.

16) Disease:
The term 'Disease' is crucial to understanding pathological conditions in patients. In the case study, defining the specific ocular issues resulting from local anesthesia helps medical professionals appreciate the importance of recognizing potential risks and managing complications to preserve patient vision and overall ocular health.

17) Family:
The term 'Family' pertains to familial history regarding health issues, which can be relevant in assessing a patient's risk factors for conditions leading to visual impairments. Understanding a patient's familial background may uncover predispositions to certain health problems, influencing both diagnosis and tailored treatment plans.

18) Nausea:
The term 'Nausea' refers to a sensation of unease or discomfort, often associated with various medical issues. Its assessment provides insights into the systemic effects of a procedure or drug. In this case, noting the absence of nausea symptoms helps narrow down the cause of the patient's visual disturbances.

19) Silver:
The term 'Silver' appears in relation to 'silver wiring,' which refers to specific changes in retinal vessels during pathological assessments. This term is relevant for identifying conditions like hypertensive retinopathy, emphasizing the importance of accurate diagnosis and differential analysis when faced with ocular complications from dental procedures.

20) Sign:
The term 'Sign' denotes any observable indication of a medical condition. In this context, eye examination signs assist in diagnosing complications stemming from local anesthesia. These signs guide medical professionals in determining injury severity and develop effective management plans to mitigate risks and ensure patient safety.

Other Science Concepts:

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Discover the significance of concepts within the article: �Loss of vision following a dental procedure- a case study�. Further sources in the context of Science might help you critically compare this page with similair documents:

Fundus examination, Hard exudates, Vasospasm, Visual field test, Ocular complications, Relative afferent pupillary defect.

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