Local anesthetics are the most commonly used drugs in dentistry. Despite preoperative patient evaluation, proper tissue preparation and meticulous administration techniques many local and systemic complications with the local anesthesia or tooth extraction have been reported from time to time. Extension of dental infections from maxillary teeth and other nearby structures to orbital spaces and tissues surrounding the eye present a rare but serious problem with the potential for causing significant impairment. The practioner should be aware of the severe consequences that may result from tooth extraction or local anesthesia.
Malden N, Kaye-Wilson LG, Hudson I, Valentine D. Transient uniocular blindness after dental extraction under general anesthetic. Br Dent J 1993;231:667–668.
Krepler K, Wedrich A, Schranz R. Intraocular hemorrhage associated wi th dental implant surgery. Am J Ophthalmol 1996;122:745–746.
Fr iberg TR. Ret inal tear af ter teeth cleaning. JAMA 1995;273:1493.
Brodsky CD, Dower JS Jr. Middle ear problems after a Gow- Gates injection. J Am Dent Assoc 2001; 132(10):1420–4.
Penarrocha-Diago M, Sanchis-Bielsa JM. Ophthalmologic complications after intraoral local anesthesia with articaine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90(1):21–4
Webber B, Orlansky H, Lipton C, Stevens M. Complications of an intra-arterial injection from an inferior alveolar nerve block. J Am Dent Assoc 2001;132(12):1702–4.
Cooper JC. Deviation of eye and transient blurring of vision after mandibular nerve anesthesia: report of a case. J Oral Surg Anesth Hosp Dent Serv 1962;20:151–2.
Rood J. Ocular complication of inferior dental nerve block. A case report. Br Dent J 1972;132(1):23–4.
De Keyzer K, Tassignon MJ. [Case report: acute unilateral loss of visual acuity after a visit to the dentist: an unusual complication after the use of an anesthetic combined with adrenaline.] Article in French. Rev Belge Med Dent 2004;59:30–3.
Rishiraj B, Epstein JB, Fine D, Nabi S, Wade NK. Permanent vision loss in one eye following administration of local anesthesia for a dental extraction. Int J Oral Maxillofac Surg 2005;34(2):220–3.
Tommazzoli-Gerosa L, Marchini G, Monaco A. Amaurosis and atrophy of the optic nerve: an unusual complication of mandibular-nerve anesthesia. Ann Ophthalmol 1988;20(5):170–1.
Wei Cheong Ngeow, Chen Kiong Shim, Wen Lin Chai. Transient Loss of Power of Accommodation in 1 Eye Following Inferior Alveolar Nerve Block: Report of 2 Cases. J Can Dent Assoc;72(10):727-31
Leopard PJ. Diplopia following injection of a local anaesthetic. Dent Pract Dent Rec 1971;22(3):92–4.
Goldenberg AS. Transient diplopia as a result of block injections. Mandibular and posterior superior alveolar. NY State Dent J 1997;63(5):29–31.
Goldenberg AS. Transient dipoplia from a posterior alveolar injection. J Endod 1990;16(11):550–1.
Goldenberg AS. Diplopia resulting from a mandibular injection. J Endod 1983;9(6):261–2.
Marinho RO. Abducent nerve palsy following dental local analgesia. Br Dent J 1995;179(2):69–70.
Pickering T, Howden R. Gray's anatomy, descriptive and surgical. 15th ed. London: Chancellor Press; 1985. p. 703–9, 805–30
Blaxter P, Britten MJ. Transient amaurosis after mandibular nerve block. Br Med J 1967; 1(5541):681.37
Pretterklieber ML, Skopakoff C, Mayr R. The human maxillary artery reinvestigated: I. Topographical relations in the infra temporal fossa. Acta Anat (Basel) 1991;142(4):281–7.
Roda RS, Blanton PL. The anatomy of local anesthesia. Quintessence Int 1994;25(1):27–38.
Singh S, Dass R. The central artery of the retina. I. Origin and course. Br J Ophthalmol 1960; 44:193–212.
Hyams SW. Oculomotor palsy following dental anesthesia. Arch Ophthalmol 1976;94(8):1281–2.
Bandres A, Penarocha M, Sanchis JM. [Complicaciones de la anestesia dental.]Anales Odontoestomatol 1997;3:87–95.
Aldrete JA, Narang R, Sada T, Tan Liem S, Miller GP. Reverse carotid flow — a possible explanation for some reactions to local anesthetic. J Am Dent Assoc 1977;94(6):1142–5.
Balaji S M. Transient diplopia in dental outpatient clinic: An uncommon iatrogenic event. Indian J Dent Res 2010;21:132-4
Hawkins JM, Isen D. Maxillary nerve block: The pterygopalitine canal approach. J Calif Dent Assoc 1998;26:658-64.
Lee C. Ocular complications after inferior alveolar nerve block. The Hongkong Medical Diary 2006;11:4-5.
Van Der Bijl P, Meyer D. Ocular complications of dental local anaesthesia. SADJ 1998;53:235-8.
Crean SJ, Powis A. Neurological complications of local anaesthetics in dentistry. Dent Update 1999;26:344-9.
Alexander Kiderman, Jawad A. A. Tair An eye for a tooth. Gerodontology 2013;30:83-84
Jones WL. Valsalva maneuver induced vitreous hemorrhage. J Am Optom Assoc 1995;66:301–304
Duane TD. Valsalva hemorrhagic retinopathy. Trans Am Ophthalmol Soc 1972;70:298–313
Peñarrocha-Diago M, Sanchis-Bielsa JM. Ophthalmologic complications after intraoral local anesthesia with articaine Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jul;90(1):21-4
Campbell RL, Mercuri LG, Van Sickels J. Cervical sympathetic block following intraoral local anesthesia. Oral Surg Oral Med Oral Pathol 1979;47:223-6.
Carron H, Litwiller R. Stellate ganglion block. Anesth Analg 1975;54:567-70.
Kronman JH, Kabani S. The neuronal basis for diplopia following local anesthetic injections. Oral Surg Oral Med Oral Pathol 1984;58:533-4.
Petrelli A, Steller RE. Medial rectus muscle palsy after dental anesthesia. Am J Ophtalmol 1980;90:422-4.
Marinho RM. Abducent nerve palsy following dental local analgesia. Br Dent J 1995;179:69-70.
Lloyd E, Scher-DuBrul, editors. Anatomía oral. Barcelona: Doyma; 1990. p. 235-58.
Okeson JP, editor. Dolor orofacial según Bell. Barcelona: Quintessence; 1999. p. 31-40.
Velayos JL, editor. Anatomía de la cabeza, con enfoque odontoestomatológico. 2nd ed. Madrid: Panamericana; 1998. p. 290-8.
Kelly R. Magliocca, Neil C. Kessel, and Gerald W. Cortright, Ann Arbor. Transient diplopia following maxillary local anesthetic injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:730-3
Walker M, Drangsholt M, Czartoski TJ, Longstreth WT Jr. Dental diplopia with transient abducens palsy. Neurology 2004;63:2449-50.
Malamed S. Techniques of maxillary anesthesia. In: Reinhardt RW, Baxter S, Stericker GB, editors. Handbook of local anesthesia. St Louis, MO: Mosby; 1997. p. 164-8.
Sved AM, Wong JD, Donkor P, Horan J, Rix L, Curtin J, et al. Complications associated with maxillary nerve block anaesthesia via the greater palatine canal. Aust Dent J 1992;37:340-5.
Subramaniam S, Tet CM, Wan Hitam WH, Hussein A, Khan SA, Pal HK, Embong Z. Orbital apex syndrome after tooth extraction in an immunocompromised patient. Int J Ophthalmol 2011;4(1):112-114
Zachariades N, Vairaktaris E, Mezitis M, Rallis G, Kokkinis C, Moschos M. Orbital abscess: visual loss following extraction of a tooth -- Case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100(4):e70-e73
Kim IK, Kim JR, Jang KS, Moon YS, Park SW. Orbital abscess from an odontogenic infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(1):e1-e6
Edward FK. Orbital apex syndrome due to sinus infection. Laryngoscope 1974;84(3):353-371
Chee E, Looi A. Onodi sinusitis presenting with orbital apex syndrome. Orbit 2009;28(6):422-424
Mehra P, Murad H. Maxillary sinus disease of odontogenic origin. Otolaryngeal Clin North Am 2004;37(2):347-364
El-Sayed Y, Al-Muhaimeid H. Acute visual loss in association with sinusitis. J Laryngeal Otol 1993;107(9):840-842
Miller EH, Kassebaum DK. Managing periorbital space abscess secondary to dentoalveolar abscess. A case report. JADA 1995;126:469-72
Allan BP, Egbert MA, Myall RWT. Orbital abscess of odontogenic origin. Case report and review of the literature. J Oral Maxillofac Surg 1991;20:268-70.
Janakarajah N, Sukumaran K. Orbital cellulitis of dental origin: case report and review of the literature. Br J Oral Maxillofac Surg 1985;23:140-5.
Gold RS, Silver L, Sager E. Pansinusitis, orbital cellulitis, and blindness as sequelae of delayed treatment of dental abscess. J Oral Surg 1974;32:40-3.
O'Ryan F, Diloreto D, Barber D, Bruckner R. Orbital infection: clinical and radiographic diagnosis and surgical treatment. J Oral Maxillofac Surg 1988;46:991-7.
Rosen D, Ardekian L, Abu El Naaj I, Fischer D, Peled M, Laufer D. Orbital infection arising from a primary tooth: a case report. Int J Ped Dent 2000;10:237-9.
Henry CH, Hughes CV, Larned DC. Odontogenic infection of the orbit. J Oral Maxillofac Surg 1992;50:172-8.
Zachariades N, Vairaktaris E, Mezitis M, Triantafyllou D, Papavassiliou D. Cerebral abscess and meningitis complicated by residual mandibular ankylosis. A study of the routes that spread the infection. J Oral Med 1986;41:14-20
