Magnetic resonance image changes following optic nerve trauma from peribulbar anaesthetic

Editor,—In this case a grand mal seizure occurred after a short peribulbar anaesthetic needle was used, permanent visual loss resulted, and magnetic resonance imaging (MRI) confirmed optic nerve damage. ### CASE REPORT A 49 year old myopic woman was diagnosed as having normal tension glaucoma. A year previously she underwent uncomplicated right trabeculectomy with 5-fluorouracil under local anaesthetic, and surgery to the left eye was planned. Her medication included levobunolol HCl 0.5% twice daily to the left eye, and atenolol for hypertension. Before left trabeculectomy, with 5-fluorouracil, corrected vision was 6/9 right eye, and 6/5 left. Intraocular pressures were 12 mm Hg and 20 mm Hg respectively. A painless peribulbar anaesthetic of prilocaine 4% was administered with a 25 mm 27 gauge needle. One injection of 3 ml was given inferotemporally and a second injection of 2.5 ml at the medial canthus. The eye remained in the primary position throughout. Light ocular compression was applied and after 10 minutes she was prepared for surgery. She then felt cold and started …