Optic neuropathy of recurrent blood loss.

and the Glasgow Eye InfirmaryLoss of vision after severe and recurrent haemorrhage, an occasional but serious complica- tion, is an established clinical entity recognized from the writings of the earliest medical authorities.Formerly thought only to follow recurrent upper gastrointestinal (Goerlitz, 1920; Bamford and Barber, 1940; Black, '945; Avery Jones, 1947; Locket, I949; Gavey, I963), uterine (Pines, 1931), or therapeutic bleeding (Esquirol, I838), it is now recognized that similar visual loss may follow open heart surgery (Lamb, I96I; Gilman, I964) and cardiac arrest (Weinberger, I962).This paper presents three instances in which the visual loss followed closely on surgery and one in which the classical pattern evolved. Case reportsCase i, a man aged 31 years, had chronic pulmonary tuberculosis with recent exacerbation treated by chemotherapy (Inahpasade 12 g./day).His vision was said to be good before admis- sion.The blood pressure on admission was I30/70 mm.Hg. Upper right lobectomy.I4.6.65 Closure of broncho-pleural fistula.I.7.65 Middle and lower right lobectomy and thoracoplasty for empyema and bronchial fistula.This was a long procedure complicated by brisk haemorrhage from the pulmonary vessels and a period of profound hypotension.An intravenous infusion, initially of blood and latterly of 5 per cent.dextrose/saline, was started at the time of operation and continued for 24 hours postoperatively; 5 pints of whole blood were transfused during the operation, and bronchoscopy and tracheostomy were performed later that day. 2.7.65The patient complained of being unable to see, and examination showed that the visual acuityin the right eye was reduced to perception of light only, while the left eye had doubtful perception of light.The pupils were semi-dilated and only the right pupil showed any reaction to light.There was slight oedema of the optic discs and adjacent retina in each eye.The retinal vessel calibre was within normal limits.A diagnosis of neuroretinal oedema secondary to hypotension was made and therapy with osmotic agents instituted.Intravenous "Ureaphil", 40 g. in 500 ml.saline was given and followed by intravenous "Mannitol".The "Mannitol" was administered as a Io per cent.solution in saline: 500 ml. of this solution was given over 6 hours and was alternated with 540 ml. 5 per cent.dextrose saline for the next 4 days.A good diuresis was obtained and maintained.