Iatrogenic ocular trauma associated with infraorbital block performed for rhinoscopy in a cat: case report and preliminary imaging findings

OBJECTIVES: This paper describes a case of endophthalmitis in a feline patient caused by globe penetration during an infraorbital block performed to provide analgesia during rhinoscopy, and presents additional imaging and dissection data demonstrating risk of iatrogenic ocular trauma during infraorbital blocks in cats when the infraorbital canal is entered. METHODS: Case records and accompanying histopathologic reports were reviewed for the feline patient. Separately, two feline cadavers were imaged using CT following placement of 5/8" 25 G needles or 1" 22 G over the needle catheters in the infraorbital canal. Infraorbital blocks with injection of trypan blue dye followed by dissection were performed in two further feline cadavers to assess the potential for globe penetration and to provide preliminary information regarding the potential efficacy of infraorbital blocks for analgesia during rhinoscopy. RESULTS: Clinical and histopathologic findings support inadvertent globe penetration during infraorbital block as the cause for endophthalmitis in the feline patient described. CT imaging and dye injection studies further demonstrate the risks involved with this local anesthetic technique in cats. CONCLUSIONS AND RELEVANCE: Further study is needed to assess the safety and efficacy of infraorbital blocks performed for rhinoscopy in cats. Catheters may be safer anesthetic delivery devices than needles. Extreme caution should be used when entering the infraorbital canal in cats.