Abstract Details

Title Visual Disturbances Caused by Massive Musculoskeletal and Mediastinal Emphysema After Hip Arthroscopy

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 17-011

Objective To describe massive gas entry into the body during hip arthroscopy as an uncommon occurrence that caused pneumomediastinum, gas tracking through the fascial planes and skull base, and infiltration of gas into the ciliary body, leading to transient visual disturbances.

Background

A 19-year-old cross country runner underwent arthroscopy of the right hip for a labrum tear. After sitting up for a four-hour drive, the patient noted significant crepitations of her lower extremities associated with numbness and tingling over her hands and feet, along with visual disturbances.

An emergency department exam revealed crepitations of the lower extremities, abdomen, chest, and neck. The patient reported blurred vision and an inability to read. Uncorrected bilateral visual acuity was 20/20 for distance vision but 20/100 for near vision. Pupils were not reactive to light, did not accommodate to near target, and were mid-dilated at 5 mm.

Design/Methods NA

Results

CT scan of the lower extremities and chest revealed massive subcutaneous emphysema involving the lower extremities, abdomen, chest, and neck, with pneumoperitoneum and pneumomediastinum.

The patient received four hyperbaric oxygen treatments (HBOT). By the third treatment, near visual acuity was 20/20. However, far visual acuity was now 20/50. This disappeared one week after discharge.

Conclusions The patient’s presentation with lack of accommodation to near target and non-reactive dilated pupils was brought about by the penetration of gas around the eye. It is proposed that small bubbles either disrupted contractility of the ciliary muscles, causing an inability of the zonules to relax and thicken the crystalline lens, disrupting the near triad, or caused paresis of the iris sphincter muscle, resulting in partial mydriasis. Additionally, HBOT is known to cause “myopic shift” by causing changes in protein function of the crystalline lens and a transient increase in refractive index and temporary shift toward myopia.

Authors/Disclosures
Aida Ansari PRESENTER	Ms. Ansari has nothing to disclose.
Samuel J. Thomas	Mr. Thomas has nothing to disclose.
Adeela Alizai, MBBS (Indiana Eye institute)	Dr. Alizai has nothing to disclose.
Mark Walsh IV, MD	Dr. Walsh has nothing to disclose.
Marium Ansari	Mrs. Ansari has nothing to disclose.
Duffy Monahan, Student	Mr. Monahan has nothing to disclose.
Mubashir Raza, MBBS	Dr. Raza has nothing to disclose.
Yusuf Raza	Mr. Raza has nothing to disclose.
Hala K. Ansari	Miss Ansari has nothing to disclose.
Jeffery M. Bao	Mr. Bao has nothing to disclose.
Syed Raza, MD	Dr. Raza has nothing to disclose.