Blindness and rectus muscle damage following spinal surgery

Purpose To report a rare case of blindness and rectus muscle damage from ocular compression after spinal surgery. Design Observational case report. Methods A 16-year-old girl underwent scoliosis surgery in the prone position. After surgery, she complained of visual loss in the right eye. Examination showed no perception of light, periorbital bruising, corneal haze, fixed dilated pupil, and loss of adduction beyond the midline. Results Orbital computed tomography scan showed a swollen medial rectus with no other orbital pathology. The muscle swelling can be explained by ischemia from compression of the globe against the medial wall of the orbit. Ocular compression also caused retinal and optic nerve ischemia, resulting in loss of vision. Medial rectus function recovered with time, but the patient continues to have no light perception. Conclusions Blindness after spinal surgery is a rare but devastating complication, and all precautions to avoid ocular compression must be taken.