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Acute angle closure glaucoma following the use of intranasal cocaine during dacryocystorhinostomy
  1. G A Wilcsek1,
  2. M J Vose2,
  3. I C Francis3,
  4. S Sharma3,
  5. M T Coroneo3
  1. 1Ocular Plastics Unit, Prince of Wales Hospital, University of New South Wales, Sydney, Australia
  2. 2Ocular Plastics Unit, Manchester Royal Eye Hospital, Manchester, UK
  3. 3Ocular Plastics Unit, Prince of Wales Hospital, University of New South Wales, Sydney, Australia
  1. Correspondence to: Professor Minas T Coroneo, Ocular Plastics Unit, Eye Clinic, Level 4, Prince of Wales Hospital, High St, Randwick, NSW, 2031, Australia; m.coroneo{at}unsw.edu.au

https://doi.org/10.1136/bjo.86.11.1312

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    Many thousands of dacryocystorhinostomies (DCRs) are performed by ophthalmologists routinely without problems. Postoperative pain and nausea may wrongly be attributed to wound pain and post-anaesthetic nausea. Medical and nursing staff need to be aware of the potential for intranasal cocaine to precipitate acute angle closure glaucoma (AACG). We report two cases of AACG following the use of intranasal cocaine and subcutaneous lignocaine (lidocaine) with adrenaline during DCR surgery. We believe this to be the second report of such cases.

    Case report

    Two women, a 67 year old and a 75 year old, developed right sided AACG immediately after ipsilateral DCR surgery. Both patients were treated successfully for AACG. Cocaine is a known mydriatic and can induce angle closure glaucoma in predisposed individuals. Adrenaline in the local anaesthetic solution and intravenous atropine sometimes used during general anaesthesia are also known mydriatics.

    We performed right sided external DCR surgery under general anaesthesia on both females. Regional preparation included a cocaine nasal pack (5% solution) and infiltration with lignocaine and adrenaline 1:200 000 at the proposed incision site subcutaneously. Preoperative intraocular pressures were within normal limits and there was no history of …

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