Transient orbital apex syndrome - with magnetic resonance imaging evidence following sub-Tenon’s ropivacaine anesthesia during combined cataract and macular surgery: a case report

Sep 29, 2026

Uploaded by Mary Man

Sub-Tenon’s anesthesia (STA) is widely used in ophthalmic regional anesthesia, yet a rare transient orbital apex syndrome (OAS) is reported after ropivacaine administration during combined cataract and macular surgery. A 71-year-old man developed acute postoperative vision loss with ptosis, ophthalmoplegia, and mydriasis. Orbital MRI showed mild perineural fluid around the optic nerve and localized retrobulbar fat edema, without compressive lesions or optic nerve thickening. Supportive therapy led to complete neurological recovery within 24 h and visual acuity improvement to 0.15.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Case presentation

Preoperative status

STA procedure

Postoperative events and examination

Imaging and diagnosis

Discussion

Conclusion

Cao et al. BMC Ophthalmology (2026) 26:3 [https://doi.org/10.1186/s12886-025-04544-4](https://doi.org/10.1186/s12886-025-04544-4) BMC Ophthalmology CASE REPORT Open Access Transient orbital apex syndrome with magnetic resonance imaging evidence following sub-Tenon’s ropivacaine anesthesia during combined cataract and macular surgery: a case report Xiang Cao 1,2, Zhencheng Ge 1,3 andYiqing Gong 1,2,4* Abstract Background Although sub-Tenon’s anesthesia (STA) is a widely accepted regional anesthesia technique in ophthalmic surgery, we report a rare case of transient orbital apex syndrome (OAS) following its administration using ropivacaine during combined cataract and macular surgery. Case presentation We describe the clinical course of a 71-year-old male who developed acute postoperative vision loss, ptosis, ophthal moplegia, and mydriasis in the operated eye following sub-Tenon’s ropivacaine injection. Orbital MRI revealed mild perineural fluid surrounding the optic nerve and localized edema of the retrobulbar fat, without evidence of compressive lesions or optic nerve thickening. The patient received supportive therapy, including oxygen, neurotrophic agents, and osmotic and microcirculation enhancers. Remarkably, all neurological signs resolved within 24 h, and visual acuity improved to 0.15. Conclusion Although STA is considered a safer alternative to needle-based techniques, this case highlights the potential for rare but reversible complications such as OAS. Early recognition and timely, supportive management contributed to the patient’s favorable recovery, although outcomes may vary in other cases. In addition, thorough preoperative counseling and vigilant postoperative monitoring are essential, particularly in elderly or high-risk patients, to ensure prompt detection and management of any unexpected complications. Keywords Sub-Tenon’s anesthesia, Ropivacaine, Orbital apex syndrome, Transient vision loss *Correspondence: Yiqing Gong [gongyiqing@outlook.com](gongyiqing@outlook.com) 1Department of Ophthalmology, Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, China 2Zhenjiang Kangfu Eye Hospital, Zhenjiang, Jiangsu 212002, China 3School of Medicine, Jiangsu University, Zhenjiang, Jiangsu 212002, China 4Present address: School of Medicine, Xiamen Eye Center and Eye Institute of Xiamen University, Xiamen, Fujian 361001, China © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Cao et al. BMC Ophthalmology (2026) 26:3 Introduction Sub-Tenon’s anesthesia (STA) is a widely accepted regional anesthesia technique in ophthalmic surgery, particularly for cataract and vitreoretinal procedures, due to its efficacy and lower risk profile compared to retrobulbar or peribulbar injections [1, 2]. Orbital apex syndrome (OAS), characterized by simultaneous dysfunction of cranial nerves II, III, IV, VI, and the ophthalmic division of V, is most commonly associated w

FAQs

What complication occurred after sub-Tenon’s ropivacaine anesthesia in this case?

The patient developed transient orbital apex syndrome with acute postoperative vision loss, ptosis, ophthalmoplegia, and mydriasis in the operated eye.

What did the orbital MRI show?

MRI showed mild perineural fluid surrounding the optic nerve and localized edema of the retrobulbar fat, with no evidence of compressive lesions or optic nerve thickening.

How was the patient treated and what was the outcome?

Supportive therapy was provided, including oxygen, neurotrophic agents, and osmotic and microcirculation enhancers. All neurological signs resolved within 24 hours, and visual acuity improved to 0.15.

Sep 29, 2026

Uploaded by Mary Man