Loss of vision caused by expansion of intraocular perfluoropropane (C(3)F(8)) gas during nitrous oxide anesthesia

Am J Ophthalmol. 2002 Nov;134(5):761-3. doi: 10.1016/s0002-9394(02)01654-9.


Purpose: To report visual loss associated with nitrous oxide anesthesia in patients with intraocular perfluoropropane (C(3)F(8)) gas.

Design: Observational case series.

Methods: Three patients are described who lost vision in the eye with intraocular gas after subsequent nitrous oxide general anesthesia.

Results: Three patients, aged 75, 80, and 73 years, with intraocular C(3)F(8) gas in three eyes underwent nitrous oxide general anesthesia in three different medical centers for conditions unrelated to their ophthalmic surgery, ranging from 10 days to 1 month after their vitreoretinal procedure. All three patients suffered visual loss due to presumed central retinal artery occlusion caused by expansion of the intraocular gas by nitrous oxide during general anesthesia. In two patients, there was no recovery of light perception. In one patient, there was moderate recovery of vision.

Conclusions: Identification of patients with intraocular gas is critical when planning nitrous oxide anesthesia. This may be achieved by the use of a simple intraocular gas identification bracelet issued to patients at the time of their vitreoretinal procedure.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anesthesia, General / adverse effects*
  • Anesthetics, Inhalation / adverse effects*
  • Blindness / chemically induced*
  • Drug Interactions
  • Fluorocarbons / adverse effects*
  • Humans
  • Intraocular Pressure / drug effects*
  • Male
  • Nitrous Oxide / adverse effects*
  • Ocular Hypertension / chemically induced
  • Retinal Artery Occlusion / chemically induced
  • Retinal Detachment / surgery
  • Retinal Hemorrhage / surgery
  • Retinal Perforations / surgery
  • Visual Acuity
  • Vitrectomy


  • Anesthetics, Inhalation
  • Fluorocarbons
  • perflutren
  • Nitrous Oxide