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Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Eye volume 21, pages 256–257 (2007)Cite this article

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Sir,

Rossiter et al1 have written a timely reminder of the problems that may result from Bell's reflex in the nonparalysed patient undergoing cataract surgery under general anaesthesia.

Bell's reflex can also be a problem in strabismus surgery leading to difficulties in interpretation of the forced duction test and impeding access to the extraocular muscles.2, 3 In a recent survey carried out in the Southwest of England, neuromuscular blocking agents were used in only 45% of children and 34% of adults undergoing strabismus surgery.4 The authors point out that conditions for forced duction test and ocular access may be less than ideal in a large proportion of patients undergoing strabismus surgery.

In paediatric ptosis surgery, it is necessary to set the height of the eyelid relative to the pupil under general anaesthetic.5 For this, the patient must be paralysed to abolish Bell's reflex at least until the levator muscle has been sutured into place.

References

  1. Rossiter JD, Wood M, Lockwood A, Lewis K . Operating conditions for ocular surgery under general anaesthesia: an eccentric problem. Eye 2006; 20(1): 55–58.

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  2. Castanera de Molina A, Giner Munoz ML . Ocular alignment under general anesthesia in congenital esotropia. J Pediatr Ophthalmol Strab 1991; 28(5): 278–282.

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  3. Harrad R . Strabismus Surgery. In: Easty D, Sparrow J (eds). Oxford Textbook of Ophthalmology. Oxford University Press: Oxford, 1999, p 1242.

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  4. Dell R, Williams B . Anaesthesia for strabismus surgery: a regional survey. Br J Anaesth 1999; 82(5): 761–763.

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  5. Tyers A, Collin J . Colour Atlas of Ophthalmic Plastic Surgery, 2nd edn. Butterworth Heinemann: London, 2001, p 161.

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  1. Bristol Eye Hospital, Lower Maudlin Street, Bristol, BS1 2LX, UK

    R A Harrad & P Stoddart

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  1. R A Harrad
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  2. P Stoddart
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Correspondence to R A Harrad.

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Harrad, R., Stoddart, P. Operating conditions for ocular surgery under general anaesthesia: an eccentric problem. Eye 21, 256–257 (2007). https://doi.org/10.1038/sj.eye.6702487

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