Haemorrhage and risk factors associated with retrobulbar/peribulbar block:a prospective study in 1383 patients

Patients undergoing intraocular surgery are elderly and may have disease or be receiving medication which increases the risk of haemorrhage. We interv iewed 1383 consecutive patients scheduled for eye surgery requiring retrobu lbar/peribulbar block about their use of nonsteroidal anti-inflammatory dru gs, oral steroids and warfarin. A history of diabetes mellitus and globe ax ial length was noted. Medial peribulbar and inferolateral retrobulbar block s were performed by three specialists and six doctors in training. The ensu ing haemorrhages were graded as follows: 1=spot ecchymosis; 2=lid ecchymosi s involving half of the lid surface area or less; 3=lid ecchymosis all arou nd the eye, no increase in intraocular pressure; 4=retrobulbar haemorrhage with increased intraocular pressure. Acetylsalicylic acid was taken by 482 (35%) patients, non-steroidal anti-inflammatory drugs by 260 (19%) and warf arin by 76 (5.5%). Lid haemorrhages (grades 1-3) were observed in 55 patien ts (4.0%); in 33 of these patients the haemorrhages were spotlike (grade 1) . No grade 4 haemorrhages occurred. The preoperative use of acetylsalicylic acid, non-steroidal anti-inflammatory drugs or warfarin, whether or not th ey had been discontinued, did not predispose to haemorrhage associated with retrobulbar/peribulbar block.