Objectives

1. Define the basic anatomic and physiologic concepts of ocular trauma.

2. Review the anesthetic implications of eye injuries, including blindness following major surgery.

3. Evaluate the use of succinylcholine in patients with open-globe injuries.

INTRODUCTION

Trauma to the eyes and resulting blindness can have life-altering impact. This chapter will present the implications for the anesthesiologist of trauma to the eye. Ocular trauma and basic anatomic and physiologic concepts will be defined and the incidence of these potentially devastating injuries will be reviewed. Anesthetic implications, including the timing of surgery, anesthetic drug selection, and other perianesthetic concerns will be addressed. The use of succinylcholine in patients with open-globe injuries is a long-standing controversy that we will discuss. Blindness following major trauma and resuscitation has significant implications for physicians caring for trauma patients.

DEFINITION

A standard terminology for eye injury that has been adopted in the United States and internationally is known as the Birmingham Eye Trauma Terminology (BETT; Figure 23.1). The entire globe is considered, and the BETT is unambiguous, consistent, and simple to use. The definitions it provides will be utilized in this chapter. The BETT system clearly defines all injuries and places each type of injury within a comprehensive system of the whole eyeball [1].

The eye wall is defined as the cornea and the sclera. A full-thickness wound of these layers is an “open-globe” injury, whereas a “closed-globe” injury does not involve a full-thickness wound (Figure 23.2, see also color plate after p. 294).