Intraoral administration of local anesthesia is inevitable for most of the procedures in endodontics. It may be accompanied by ocular complications that are reasonably rare and transient in nature but can cause discomfort for both the patient and the clinician. Most literatures have reported complications that occurred ipsilateral to the injection site. Very rarely contralateral disturbances of eyes are reported. This case series reports two cases in which one case was followed by ptosis, pain, and discomfort of an eye after administering an inferior alveolar nerve block. The other was immediately followed by twitching, pain, and discomfort of an eye after the maxillary infiltration technique. Complete recovery was achieved without any interventions. In this article, we are reporting multiple cases of contralateral complications along with a scientific explanation for this phenomenon and its prevention and management.
Key messages: Although contralateral ocular complications are transient, potential sequelae including blindness should be considered. Measures like initial aspiration, slow injection of anesthetic solution, usage of a 25-G needle, and management of patient anxiety reduce the chance of ocular complications.
Chisci G, Chisci C, Chisci V, et al. Ocular complications after posterior superior alveolar nerve block: a case of trochlear nerve palsy. Int J Oral Maxillofac Surg 2013;42(12):1562–1565. DOI: 10.1016/j.ijom.2013.05.010.
Boynes SG, Echeverria Z, Abdulwahab M. Ocular complications associated with local anesthesia administration in dentistry. Dent Clin North Am 2010;54(4):677–686. DOI: 10.1016/j.cden.2010.06.008.
Pandey R, Dixit N, Dixit KK, et al. Amaurosis, an unusual complication secondary to inferior alveolar nerve anesthesia: a case report and literature review. J Endod 2018;44(9):1442–1444. DOI: 10.1016/j.joen.2018.05.005.
Scarano A, Sinjari B, Lorusso F, et al. Intense, instantaneous, and shooting pain during local anesthesia for implant surgery. J Craniofac Surg 2018;29(8):2287–2290. DOI: 10.1097/SCS.0000000000004575.
von Arx T, Lozanoff S, Zinkernagel M. Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations. Swiss Dent J 2014;124(11):1189–1203.
Melé MV, Puigdellívol-Sánchez A, Mavar-Haramija M, et al. Review of the main surgical and angiographic-oriented classifications of the course of the internal carotid artery through a novel interactive 3D model. Neurosurg Rev 2020;43(2):473–482. DOI: 10.1007/s10143-018-1012-7.
Kini YK, Kharkar VR, Kini AY. Transient diplopia with ipsilateral abducent nerve palsy and ptosis following a maxillary local anesthetic injection: a case report and review of literature. Oral Maxillofac Surg 2012;16(4):373–375. DOI: 10.1007/s10006-011-0304-7.
Kempster C, Ghabriel M, Kaidonis G, et al. An unusual ocular complication following dental anaesthesia: case report. Aust Dent J 2016;61(3):374–380. DOI: 10.1111/adj.12392.
Malamed SF. Handbook of local anesthesia. 6th ed., St Louis: Elsevier; 2013. pp. 311–340.
Steenen SA, Dubois L, Saeed P, et al. Ophthalmologic complications after intraoral local anesthesia: case report and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113(6):e1–e5. DOI: 10.1016/j.tripleo.2011.07.032.
Pragasm M, Managutti A. Diplopia with local anesthesia. Natl J Maxillofac Surg 2011;2(1):82–85. DOI: 10.4103/0975-5950.85861.