ABSTRACT
Background:
The most significant medications in dentistry are local anesthetics, and intraoral local anesthesia is arguably the most used dental procedure. However, complications have also been reported.
Aim:
Evaluation of ocular complications in intraoral anesthesia.
Materials and Methods:
It was a prospective study involving 2,400 patients undergoing different dental procedures that were performed under intraoral local anesthesia over a 12-month period. There was a thorough ocular evaluation of all patients by ophthalmologist before and after the administration of intraoral local anesthesia.
Results:
There were different types of ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing 40.1% of all ocular complications. It was followed by ptosis (16.9%), mydriasis (14.9%), and amaourosis (13.2%).
Conclusion:
The most common ocular complication in intraoral local anesthesia was diplopia.
KEYWORDS: Intraoral, local anesthesia, ocular, complications
INTRODUCTION
The most significant medications in dentistry are local anesthetics, and intraoral local anesthesia is arguably the most used dental procedure. However, side effects, hemorrhages, infections, brain damage, and anesthesia failures are extremely uncommon.[1,2,3] The literature hardly ever reports on the prevalence of ophthalmologic problems after dental anesthesia. The eyes play a crucial role in nonverbal interaction and expressions of emotion in addition to visual perception. Anxiety and psychological strain can be brought on by vision illnesses especially when an unforeseen and rapid ocular reaction happens. When intraoral local anesthesia is used, the ophthalmologic problems usually occur immediately or shortly after the anesthesia wears off. Most typically, the anesthetic solution entering the orbit or surrounding structures is the cause of these symptoms.[4,5]
Since Brain (1936) originally described an ophthalmologic problem following dental anesthesia, a number of case reports as well as review studies have been revealed.[2,3,4] However only a few studies have been conducted to evaluate the ophthalmic complications after intraoral anesthesia. Therefore, this study was conducted to evaluate ocular complications following intraoral local anesthesia.
METHODS AND MATERIALS
It was a prospective study involving all patients undergoing different dental procedures that were performed under intraoral local anesthesia over a 12-month period. There were 2,400 patients who were included in this study. Patients with a previous history of ocular disease were not included in the study. Patients with history of allergic reactions with local anesthetic reagents were also excluded. There was a thorough ocular evaluation of all patients by an ophthalmologist before and after administration of intraoral local anesthesia. There was proper collection of details of type of ocular complications, number of complications per patient. There was recording of details of study participants like age, gender, onset of complication, duration of complications and technique of local anesthesia administered.
Statistical analysis
The findings were recorded and entered in an MS Excel sheet. SPSS software version 21 was used for statistical analysis. The Chi-square test and ANOVA test were used for statistical analysis. P value at ≤0.05 was considered statistically significant.
RESULTS
In this study, 130 patients out of 2,400 patients (5.41%) were found to have ocular complications. Total number of ocular complications was found to be 216. Most of the patients with ocular complications (74%) were found to have one ocular complication followed by 2, 3, 4, and 5 ocular complications per patient. [Table 1]. There were different types of ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing 40.1% of all ocular complications. It was followed by ptosis (16.9%), mydriasis (14.9%), and amaourosis (13.2%). Females were more commonly affected. The most common age group affected by ocular complications was 21–30 years. Most of the ocular complications were found to have immediate onset after intraoral local anesthesia. The duration of ocular complications was quite variable. It was ranging from 5 min to permanent duration [Table 2]. The ocular complications were maximum in the inferior alveolar nerve block (45.9%) and posterior superior alveolar nerve block (40.4%). The anterior superior nerve block was found to have minimum ocular complications. The findings were significant statistically (P = 0.001) [Table 3].
Table 1.
Number of ocular complications per patient (n=130)
| No of ophthalmic complications per patient | 1 | 2 | 3 | 4 | 5 | Total |
|---|---|---|---|---|---|---|
| No of patients | 74 | 34 | 16 | 4 | 2 | 130 |
| No of complications | 74 | 68 | 48 | 16 | 10 | 216 |
Table 2.
Data regarding age, gender, onset, and duration per complication (n=216)
| Ophthalmologic complication (%) | ||||||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| Accommodation disturbance | Amaurosis | Diplopia | Enophthalmos | Miosis | Mydriasis | Ophthalmoplegia | Ptosis | |
| Percentage | 3.8 | 13.2 | 40.1 | 3.8 | 4.7 | 14.9 | 3.9 | 16.9 |
| % of females per group | 99 | 51 | 81.5 | 75.2 | 80.2 | 62.7 | 50.4 | 72.3 |
| Age (years) of patient | 21–32 | 17–74 | 6–74 | 20–66 | 20–66 | 8–62 | 20–46 | 5–66 |
| Onset of complication | Immediate to 40 min | Immediate to 3 h | Immediate to 4 h | * | Immediate to 2 min | Immediate to a few minutes | Immediate to 3 min | Immediate to 10 min |
| Duration of complication | 10 min to 3 h | 5 min to permanent | 10 min to 4 weeks | 20 min to 6 h | 20 min to 6 h | 20 min to 4 weeks | 20 min to 6 h | 20 min to 4 months |
Table 3.
Type of anesthesia associated with ophthalmologic complication
| IAN=Inferior alveolar nerve | ASA=Anterior superior alveolar nerve | MSA=Middle superior alveolar nerve | PSA=Posterior superior alveolar nerve | GP=Greater palatine nerve | |
|---|---|---|---|---|---|
| n | 66 | 2 | 10 | 58 | 8 |
| % | 45.9 | 1.5 | 6.8 | 40.4 | 5.7 |
| P | 0.001 |
DISCUSSION
This study was conducted to evaluate ocular complications after the administration of intraoral local anesthesia.
In this study, 130 (5.41%) patients were found to have ocular complications. Total number of ocular complications was found to be 216. In this study, there were different types of ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing 40.1% of all ocular complications. It was followed by ptosis (16.9%), mydriasis (14.9%), and amaourosis (13.2%).
There are some previous case reports which have shown ocular complications in intraoral local anesthesia. Out of 1,518 dental anesthesia patients, a previous study documented that only two (0.13%) had ophthalmologic problems in their prospective study. In a 15-year monitoring period, another study reported only 14 individuals who had ophthalmologic problems out of about 50,000 intraoral anesthesia patients (0.03%).[2,3,4,5]
Females were more commonly affected. The most common age group affected by ocular complications was 21–30 years. Most of the ocular complications were found to have immediate onset after intraoral local anesthesia. The duration of ocular complications was quite variable. It ranged from 5 min to a permanent duration.
The fact that 72.3% of the patients in the evaluation were female was startling and raised the likelihood that distinct anatomic features exist for different genders. For example, females may have anatomical variants more frequently than males, and because of their smaller bodies, females may have local anesthetic application locations closer to the orbit.[1,2,3,4]
CONCLUSION
There were ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing to all ocular complications.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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