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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. 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BMC Ophthalmology (2026) 26:3 [https://doi.org/10.1186/s12886-025-04544-4](https://doi.org/10.1186/s12886-025-04544-4)  \nBMC Ophthalmology  \nCASE REPORT Open Access  \nTransient orbital apex syndrome   \nwith magnetic resonance imaging evidence following sub-Tenon’s ropivacaine anesthesia during combined cataract and macular surgery: a case report  \nXiang Cao 1,2, Zhencheng Ge 1,3 andYiqing Gong 1,2,4*  \nAbstract  \nBackground 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.  \nCase 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.  \nConclusion 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.  \nKeywords Sub-Tenon’s anesthesia, Ropivacaine, Orbital apex syndrome, Transient vision loss  \n*Correspondence:  \nYiqing Gong  \n[gongyiqing@outlook.com](gongyiqing@outlook.com)  \n1Department of Ophthalmology, Affiliated People’s Hospital, Jiangsu University, Zhenjiang, Jiangsu 212002, China  \n2Zhenjiang 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  \n© 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/.  \nCao et al. BMC Ophthalmology (2026) 26:3  \nIntroduction  \nSub-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","cbCaiisrEryZHaxf","https://ap.wps.com/l/cbCaiisrEryZHaxf","pdf",857537,"English","# Introduction\n# Case presentation\n## Preoperative status\n## STA procedure\n## Postoperative events and examination\n## Imaging and diagnosis\n# Discussion\n# Conclusion","[{\"question\":\"What complication occurred after sub-Tenon’s ropivacaine anesthesia in this case?\",\"answer\":\"The patient developed transient orbital apex syndrome with acute postoperative vision loss, ptosis, ophthalmoplegia, and mydriasis in the operated eye.\"},{\"question\":\"What did the orbital MRI show?\",\"answer\":\"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.\"},{\"question\":\"How was the patient treated and what was the outcome?\",\"answer\":\"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.\"}]","Transient orbital apex syndrome - with magnetic resonance imaging evidence following sub-Tenon’s ropivacaine anesthesia during combined cataract and macular surgery: a case report | PDF",1790700007,13]