Ocular Anesthesia–Induced Injury

How eye anesthesia is commonly given
Types of ocular anesthesia–induced injury
Causes
Symptoms and signs
Diagnostic tests
Non-pharmacological treatments
Drug treatments
Dietary “molecular” supplements
Regenerative / biologic / stem-cell–related” therapies
Surgeries
Smart prevention steps
When to see a doctor
What to eat—and what to avoid
Frequently Asked Questions

Ocular anesthesia–induced injury is harm to the eye or the area around the eye caused by the way eye anesthesia is given or by the anesthetic drug itself. Eye anesthesia is used to stop pain and stop eye movement during exams and surgeries. Doctors can put drops on the surface of the eye, inject medicine around or behind the eye with a small needle, or place medicine inside the eye during surgery. These methods are normally safe. But they can rarely cause problems such as bleeding in the orbit, pressure on the optic nerve, direct damage to the eyeball, inflammation from toxic chemicals, muscle weakness, or even problems in the brainstem if medicine spreads backwards along the nerve sheath. Most injuries are rare, but because the eye is delicate, even small injuries can matter a lot. StatPearlsNCBIEyeWiki

The eye has many tightly packed, important parts. The cornea needs a smooth surface to focus light. The lens must stay clear. The retina and optic nerve must get steady blood flow. The eye muscles must move smoothly. When anesthesia is done correctly, these parts are protected. When something goes wrong—like a needle going too deep, bleeding that fills the tight space in the orbit, or a solution that is not meant for the eye—it can reduce blood flow, injure nerves, or irritate delicate tissues. Some problems heal on their own. Others need urgent treatment to prevent lasting vision loss. PMCEyeWiki

How eye anesthesia is commonly given

Topical anesthesia means drops or gel on the surface of the eye. This numbs the cornea and conjunctiva. It is common for cataract surgery and office procedures. It avoids needles but can irritate the surface if overused.
Subconjunctival or sub-Tenon’s anesthesia means medicine placed under the eye’s surface membranes through a small cut or blunt cannula. It provides comfort and some eye “stillness” with lower risk of deep needle injury.
Peribulbar or retrobulbar block means injections around or behind the eyeball to fully numb and stop movement. This is very effective but needs skill. The needle can in rare cases injure the globe, the optic nerve, or blood vessels, or allow medicine to spread backwards. StatPearlsNCBI

Types of ocular anesthesia–induced injury

It helps to group injuries by the main thing that went wrong.

Mechanical injuries (needle or instrument trauma).
A needle can pierce the sclera and retina (“globe perforation”). It can hit the optic nerve. A blunt cannula can rarely dissect tissue in the wrong plane. These injuries are uncommon but serious and can cause sudden pain, vision loss, or bleeding inside the eye. NCBIPMC
Bleeding injuries (retrobulbar or orbital hemorrhage).
A small vessel can tear during an injection. Blood collects in the tight space behind the eyeball. The eye can bulge forward, lids swell, and vision can drop from pressure on the optic nerve. This is an emergency. EyeWiki
Pressure/compartment injuries.
Large volumes of anesthetic in the orbit can raise pressure. Swelling or bleeding can also raise pressure. High pressure can squeeze the optic nerve or its blood supply.
Vascular occlusion injuries.
Rarely, spasm or compression can reduce blood flow in the central retinal artery or vein. That can cause sudden, severe vision loss if not relieved quickly. ScienceDirect
Neurotoxic or myotoxic injuries.
Local anesthetics are usually safe, but at high concentration or if they sit within a muscle, they can injure muscle fibers (myotoxicity). This can lead to double vision or limited movement for days to weeks. The optic nerve can also be injured by direct trauma or pressure. PMC
Surface toxicity injuries (cornea and conjunctiva).
Frequent topical anesthetic drops can slow corneal healing and cause ulcers or even corneal melting if abused. Strong antiseptics or the wrong concentration of solutions can also damage the corneal surface. EyeWikiCureusPMC
Inflammatory/chemical injuries inside the eye (TASS).
If a non-infectious, irritating substance reaches the front of the eye during surgery—like preservatives, wrong dilutions, or residue on instruments—it can trigger toxic anterior segment syndrome (TASS) with severe inflammation, corneal swelling, and high pressure within hours. The key is that this is not an infection, but it can still threaten vision if not treated fast. Anesthetics placed inside the eye must be preservative-free and properly diluted to avoid this problem. PMCGlaucoma Today
Infectious injuries (endophthalmitis or cellulitis).
Infection after an injection is rare when proper antisepsis is used, but it can happen if microbes enter with the needle or from the surface. Good antisepsis with povidone-iodine or appropriately diluted chlorhexidine helps prevent this. PMCAjo
Spread of anesthetic to the brainstem.
Very rarely, medicine can track backwards along the optic nerve sheath to the brainstem. This can cause confusion, trouble breathing, or sleepiness and is dangerous. Careful technique and awareness reduce the risk. Cureus
Allergic or sensitivity reactions.
True allergy to local anesthetics is uncommon, but preservatives or antiseptics can cause reactions on the surface or lids.
Statistics note (reassurance with realism).
Modern eye-block injuries are uncommon; for example, published estimates show low ocular injury rates with both retrobulbar and peribulbar blocks, with exact numbers depending on technique and definitions. Even so, because the impact can be large, teams take these risks seriously and monitor closely. EyeWiki

Causes

Deep needle placement that pierces the eye wall. The tip goes too far and enters the globe. This can cause bleeding or retinal detachment. NCBI
Needle contact with the optic nerve. The needle touches or penetrates the nerve, risking permanent vision loss. PMC
Retrobulbar hemorrhage from a torn vessel. Blood fills the orbit after an injection, pushing the eye forward and squeezing the nerve. EyeWiki
High orbital pressure from a large injected volume. Too much fluid in a small space raises pressure and reduces blood flow.
Accidental injection within an extraocular muscle. Direct muscle exposure to anesthetic causes toxic muscle fiber injury and later double vision. PMC
Anesthetic tracking into the optic nerve sheath to the brainstem. Backward spread depresses breathing and consciousness. Cureus
Arterial spasm or compression causing retinal ischemia. The central retinal artery can spasm or be compressed by pressure or volume. ScienceDirect
Wrong solution or wrong concentration in the eye. Preservatives or incorrect dilutions inside the eye trigger TASS. PMCGlaucoma Today
Surface toxicity from frequent topical anesthetic drops. Overuse slows healing and can cause persistent defects or ulcers. EyeWikiCureus
Strong or misapplied antiseptics on the cornea. Povidone-iodine or chlorhexidine at improper strengths or contact time can irritate or injure the epithelium. PMC+1
Instrument or cannula misplacement in sub-Tenon’s plane. A blunt cannula that dissects the wrong layer can cause bleeding or swelling.
Infection entering with a needle. If antisepsis fails, microbes can enter and cause cellulitis or endophthalmitis. Proper antiseptic use reduces this risk. Ajo
Chemical mismatch in irrigating fluids or injections. Wrong osmolality or pH damages endothelium and lens. (Example: diluting drugs in sterile water instead of balanced salt solution.) PMC
Allergic reaction to preservatives or latex. The surface can swell, itch, or get red and painful.
Coagulation problems or blood thinners. Easier bleeding makes even small vessel injuries more likely to expand. EyeWiki
Anatomy that makes blocks harder. Very long eyes, small orbits, or scarring can make safe paths narrower and raise risk. PMC
Poor patient cooperation during injection. Sudden movement while the needle is near the globe raises risk of mechanical injury.
Inadequate training or rushed technique. Inconsistent needle angle, depth, or aspiration checks increase risk.
Contaminated instruments or solutions. Residue or biofilm on devices or wrong cleaning steps can lead to TASS or infection. PMC
Use of epinephrine or vasoconstrictors in the wrong context. Excess local vasoconstriction can worsen ischemia in susceptible tissues. (General ophthalmic caution informed by vascular occlusion reports.) ScienceDirect

Symptoms and signs

Sudden eye pain or deep ache soon after injection—may signal bleeding, pressure rise, or globe injury. EyeWiki
Rapid eyelid swelling and bruising—suggests retrobulbar hemorrhage. The eye may feel hard. EyeWiki
Bulging eye (proptosis)—often from bleeding or swelling behind the eye. EyeWiki
Drop in vision or “curtain” over vision—could be retinal ischemia, optic nerve injury, or intraocular damage. ScienceDirect
New double vision—from muscle injury, nerve problem, or pressure on muscles. PMC
Eye that won’t move well—from successful anesthesia early on, but if it persists or is uneven later it can signal myotoxicity or nerve damage. PMC
Severe light sensitivity and tearing—often from corneal surface damage or persistent epithelial defect. NCBI
Foreign-body sensation or scratchy pain—typical of corneal epithelial injury or toxic surface reaction. EyeWiki
Hazy cornea and blurred vision hours after surgery—may be TASS if paired with inflammation and high pressure. PMC
Marked redness with pain and reduced vision—can be TASS or infection; timing and exam help tell them apart. ScienceDirect
Pupil that does not react normally—can signal optic nerve dysfunction or ischemia.
Color vision suddenly worse—often an early sign of optic nerve trouble.
Headache, dizziness, or sleepiness after a block—rarely from brainstem spread; needs urgent monitoring. Cureus
Nausea or slow heart rate—can be part of the oculocardiac reflex or stress response during eye manipulation.
Raised eye pressure with pain—seen in retrobulbar hemorrhage or TASS and needs prompt treatment. EyeWikiPMC

Diagnostic tests

Doctors choose tests based on symptoms and timing. The goal is to confirm the problem quickly and protect vision.

A) Physical examination (bedside checks)

Visual acuity (each eye, with pinhole). Tells how much vision has changed and helps triage urgency.
External inspection. Looks for swelling, bruising, wounds, or bulging that suggest bleeding or pressure. EyeWiki
Pupil exam with a light (including RAPD test). Checks optic nerve function and symmetry.
Extraocular movement testing in all directions. Distinguishes anesthesia effect from muscle or nerve injury. PMC
Color vision plates (Ishihara) or red desaturation. Sensitive to optic nerve dysfunction.
Confrontation visual fields. Screens for field loss from optic nerve or retinal ischemia.
Palpation of orbital tension (gentle). A very firm eye and tense lids support a diagnosis of retrobulbar hemorrhage. EyeWiki
Intraocular pressure measurement (tonometry). High pressures can signal TASS, hemorrhage, or angle compromise. PMC

B) Manual or bedside ophthalmic procedures

Slit-lamp examination. Gives a magnified view of the cornea, anterior chamber, and lens to find surface toxicity, cells/flare, or edema.
Fluorescein staining of the cornea. Highlights scratches, ulcers, or persistent epithelial defects from toxic drops or misuse. EyeWikiNCBI
Seidel test. Uses fluorescein to check for aqueous leakage from a wound if globe perforation is suspected.
Dilated fundus examination. Checks the retina and optic nerve for bleeding, tears, retinal whitening (ischemia), or swelling. ScienceDirect
Forced-duction test (under topical anesthesia). Distinguishes mechanical restriction (e.g., muscle injury) from nerve palsy when movements are limited. PMC
Cover–uncover and alternate cover tests. Quantify double vision or new strabismus after myotoxicity resolves.
Gonioscopy (if pressure is high). Looks at the drainage angle when TASS or hemorrhage raises IOP.

C) Laboratory and pathological tests

Complete blood count (CBC) and basic inflammation markers (ESR/CRP). Helpful if infection is suspected or if systemic inflammation is in the picture.
Coagulation profile. Aids decision-making when bleeding or hematoma occurs, especially in patients on blood thinners. EyeWiki
Aqueous or vitreous tap for Gram stain and cultures (when endophthalmitis is suspected). Confirms infection and guides antibiotics; negative results may support TASS over infection. ScienceDirect
Analysis of surgical solutions/instruments in an outbreak. When multiple cases suggest TASS, teams may audit dilutions, detergents, and lot numbers to find the source. PMC
Drug or preservative checks. Verifies that any intracameral anesthetic or adjuvant is preservative-free and correctly diluted. PMCGlaucoma Today

D) Electrodiagnostic tests

Visual evoked potential (VEP). Measures the brain’s response to visual signals; helps assess optic nerve function when the eye is otherwise clear.
Electroretinography (ERG). Measures retinal function; helpful when retinal ischemia is suspected and the view is limited.
Electro-oculography (EOG) or targeted EMG. Rarely used, but can help in complex muscle or nerve cases to confirm persistent myotoxicity.

E) Imaging tests

B-scan ocular ultrasound. Rapid bedside tool if the view is blocked by bleeding or swelling; detects globe perforation, vitreous hemorrhage, or retinal detachment.
Orbital CT scan (non-contrast). Fast, widely available; shows retrobulbar hemorrhage, emphysema, globe contour, and bone anatomy. EyeWiki
MRI of the orbits and brain. Better for soft tissues and the optic nerve when nerve injury is suspected; also helps evaluate brainstem complications. PMC
Optical coherence tomography (OCT) of the macula and nerve. Detects subtle retinal or nerve fiber layer changes after ischemia or pressure.
Fluorescein angiography. Maps retinal blood flow in suspected artery or vein occlusion. ScienceDirect
Anterior-segment OCT or ultrasound biomicroscopy. Detailed view of the cornea, angle, and lens when TASS or wound problems are present. PMC
Fundus photography. Documents baseline and changes over time.

Non-pharmacological treatments

Each item explains what it is, purpose, and how it works.

Absolute stop of topical anesthetic drops
Purpose: Remove the root cause of surface toxicity.
How it works: Stopping the toxic exposure allows corneal cells to restart normal division and migration so the epithelium can close and heal. This is the single most important step for anesthetic-abuse keratopathy. EyeWikiPubMed
Frequent, preservative-free lubrication (single-use artificial tears and ointments)
Purpose: Keep the cornea wet, protect from friction, and support healing.
How it works: Tears dilute inflammatory molecules and reduce mechanical micro-trauma with blinking, letting the epithelial edge knit together.
Bandage contact lens (BCL) (placed by an eye specialist)
Purpose: “Splint” the corneal surface to reduce pain and shield nerve endings.
How it works: A soft lens covers the defect so eyelid blinking doesn’t rub the raw surface, helping cells migrate under a protected environment.
Moisture chamber goggles or nighttime eye taping
Purpose: Prevent overnight drying that keeps wounds from closing.
How it works: Seals in humidity, slows tear evaporation, and reduces exposure keratopathy.
Punctal plugs
Purpose: Keep natural and artificial tears on the eye longer.
How it works: Tiny silicone plugs placed in the tear drainage ducts slow tear outflow, raising tear volume on the cornea.
Warm compresses and lid hygiene
Purpose: Improve meibomian gland oil flow to stabilize the tear film.
How it works: Gentle heat and lid cleansing thin and express oils that form the outer tear layer, lowering evaporation and irritation.
Scleral lens (specialist-fitted)
Purpose: Create a fluid reservoir over the cornea for constant protection.
How it works: A large rigid lens vaults the cornea and holds sterile saline against it all day, giving pain relief and promoting closure of defects.
Amniotic membrane (device form, e.g., self-retaining ring)
Purpose: Speed corneal surface healing.
How it works: Provides a biologic “bandage” with growth factors and anti-inflammatory effects that reduce scarring and help epithelial cells migrate.
Protective eye shield and activity modification
Purpose: Prevent accidental rubbing or trauma during healing.
How it works: A rigid shield and “no-rub” instructions reduce re-injury of delicate new epithelium.
Cool compresses for pain/chemosis
Purpose: Calm surface inflammation and swelling.
How it works: Cool temperature causes vasoconstriction, which reduces edema and discomfort.
Humidifier and environmental adjustments
Purpose: Raise ambient humidity at home/work.
How it works: Moist air slows tear evaporation and helps a compromised surface feel and heal better.
Nutritional optimization (protein and vitamin-rich diet)
Purpose: Support collagen formation and cellular repair.
How it works: Adequate protein plus vitamins A and C supply building blocks for epithelial and stromal healing.
Smoking cessation
Purpose: Improve oxygen delivery and wound healing.
How it works: Quitting smoking reduces oxidative stress and improves microcirculation, which helps the cornea heal.
Glycemic control in diabetes
Purpose: Reduce delayed epithelial healing common in diabetics.
How it works: Better glucose control improves nerve function and cell repair rates.
Education and psychological support (especially in anesthetic-drop misuse)
Purpose: Prevent relapse and address pain-coping needs.
How it works: Clear counseling, sometimes with mental-health support, reduces the urge to self-medicate pain with numbing drops. EyeWiki
Close follow-up with fluorescein staining
Purpose: Ensure the defect is shrinking and not infected.
How it works: Stain shows exact wound edges; frequent checks guide therapy intensity.
Eyelid taping or temporary tarsorrhaphy (non-surgical adhesive)
Purpose: Protect a non-blinking or partially closing eyelid.
How it works: Gently closes the lids to prevent exposure drying during healing.
Rapid recognition and bedside decompression for retrobulbar hemorrhage
Purpose: Save vision by quickly relieving sight-threatening pressure.
How it works: If a post-injection bleed causes high orbital pressure, urgent lateral canthotomy and cantholysis (a quick eyelid corner release) can restore blood flow to the retina/optic nerve. NCBIEyeWiki
Observation with head elevation after minor injection-related bruising
Purpose: Let small, non-compressive bleeds resolve safely.
How it works: Gravity and time reduce edema while the team watches for any warning changes.
Switching to safer anesthesia techniques next time
Purpose: Prevent recurrence in high-risk eyes.
How it works: Choosing sub-Tenon’s or topical/anterior techniques (when appropriate) and using shorter needles, careful angles, and gentle volumes can lower risk of globe or vessel injury. ScienceDirect

Drug treatments

Always use prescription treatments only under an eye specialist’s direction. Doses below are common examples, not personal medical advice.

Preservative-free ocular lubricants (carboxymethylcellulose, hyaluronate, ointments)
Dose/Timing: Tears hourly to six times daily; ointment at bedtime.
Purpose: Surface protection and pain relief.
Mechanism: Replaces tear volume; lowers friction; stabilizes the tear film.
Side effects: Temporary blur after ointment; rare allergy.
Topical antibiotic prophylaxis (e.g., moxifloxacin 0.5% or ofloxacin 0.3%)
Dose/Timing: 1 drop 4×/day if an epithelial defect is present until healed.
Purpose: Prevent secondary infection of a non-healing defect.
Mechanism: Broad-spectrum antibacterial coverage during re-epithelialization.
Side effects: Stinging; rare allergy; resistance concerns if prolonged.
Cycloplegic for pain/spasm (cyclopentolate 1% 1–3×/day or atropine 1% daily)
Purpose: Reduce ciliary spasm pain and photophobia.
Mechanism: Temporarily relaxes ciliary muscle and dilates the pupil.
Side effects: Blurry near vision, light sensitivity; avoid in narrow angles.
Short, careful course of topical corticosteroid (e.g., prednisolone acetate 1% 2–4×/day)
Purpose: Control sterile inflammation once infection is excluded.
Mechanism: Suppresses inflammatory pathways that slow healing.
Side effects: Raises eye pressure in responders; delayed healing if overused; never start if infection is suspected. (Topical steroids are used cautiously or avoided in anesthetic-abuse keratopathy.) EyeWiki
Oral doxycycline (e.g., 50 mg twice daily)
Purpose: Reduce corneal collagen breakdown (“melting”) risk and calm inflammation.
Mechanism: Inhibits matrix metalloproteinases (MMP-2/9), stabilizing stromal collagen; has anti-inflammatory effects.
Side effects: Photosensitivity, GI upset; avoid in pregnancy/children. PMCLippincott Journals
Topical N-acetylcysteine (compounded 5–10% 3–4×/day) when filaments form
Purpose: Dissolve filaments and reduce mucus strands that stick to the cornea.
Mechanism: Mucolytic action breaks disulfide bonds in mucous filaments.
Side effects: Stinging; needs compounding pharmacy.
IOP-lowering agents for post-injection pressure spikes (e.g., timolol 0.5% BID, brimonidine 0.2% TID)
Purpose: Temporarily reduce eye pressure that threatens perfusion.
Mechanism: Lowers aqueous production and/or increases outflow.
Side effects: Burning; systemic beta-blocker effects (timolol) in susceptible patients.
Systemic acetazolamide (250–500 mg PO/IV) (specialist-directed)
Purpose: Rapidly decrease intraocular pressure when needed (e.g., compressive retrobulbar hemorrhage while preparing for decompression).
Mechanism: Carbonic anhydrase inhibition lowers aqueous production.
Side effects: Paresthesias, diuresis, metabolic acidosis; avoid in sulfa allergy.
Topical immunomodulators for ocular-surface inflammation (cyclosporine 0.05–0.1% BID, lifitegrast 5% BID)
Purpose: Reduce chronic surface inflammation that blocks healing once acute toxicity is controlled.
Mechanism: T-cell–targeted immunomodulation improves tear film and epithelial health over weeks.
Side effects: Burning/irritation; slow onset (4–8 weeks).
Cenegermin (rhNGF) 20 mcg/mL (brand: Oxervate)
Dose/Timing: 1 drop in the affected eye(s) six times daily at 2-hour intervals for 8 weeks.
Purpose: Treat neurotrophic keratitis (a frequent endpoint of anesthetic damage to corneal nerves) by stimulating nerve and epithelial healing.
Mechanism: Recombinant human nerve growth factor supports corneal nerve regeneration and restores epithelial integrity.
Side effects: Eye pain, redness, increased lacrimation. OXERVATE® (cenegermin-bkbj)EyeWikiNCBI

Dietary “molecular” supplements

These are supportive and not a replacement for medical/surgical care. Discuss with your clinician, especially if pregnant, on anticoagulants, or with chronic illness.

Vitamin C (ascorbic acid) – 500–1000 mg/day
Function/Mechanism: Collagen co-factor; supports stromal repair and reduces corneal melt risk; antioxidant.
Vitamin A (dietary beta-carotene or medical vitamin A if deficient) – food-based; avoid high-dose pills unless prescribed
Function/Mechanism: Epithelial differentiation and mucin production; deficiency slows healing.
Omega-3 fatty acids (EPA/DHA) – 1–2 g/day combined EPA+DHA
Function/Mechanism: Modulates meibomian gland inflammation and may improve tear stability; clinical trial results are mixed, but many patients report symptom relief.
Zinc (with copper if long-term) – 8–11 mg/day zinc; add 1–2 mg copper if >2–3 months
Function/Mechanism: Enzyme co-factor for tissue repair and immunity.
Vitamin D3 – 800–2000 IU/day (as directed)
Function/Mechanism: Immune modulation; deficiency is linked to surface inflammation in some studies.
L-carnitine – 500–1000 mg/day
Function/Mechanism: May reduce osmotic stress and inflammation on the ocular surface (limited clinical data).
Curcumin – 500–1000 mg/day of standardized extract
Function/Mechanism: Anti-inflammatory antioxidant; may modulate NF-κB pathways.
Oral hyaluronic acid – 120–240 mg/day
Function/Mechanism: Systemic HA may support mucosal hydration; ocular data are limited.
N-acetylcysteine (oral) – 600 mg/day
Function/Mechanism: Antioxidant and mucolytic; may help with filament formation and oxidative stress.
Lactoferrin – 250–350 mg/day
Function/Mechanism: Tear protein with antimicrobial and anti-inflammatory actions; small studies suggest symptom benefits in dry-eye-like states.

Regenerative / biologic / stem-cell–related” therapies

Cenegermin (rhNGF) 20 mcg/mL
Dose: 1 drop, 6×/day for 8 weeks.
Function: Re-grows corneal nerves; promotes epithelial healing in neurotrophic keratitis.
Mechanism: Nerve growth factor restores trophic support to corneal epithelium. OXERVATE® (cenegermin-bkbj)EyeWiki
Autologous Serum Tears (AST) (20–50% dilution, 6–8×/day)
Function: Supplies growth factors, vitamins, and tear proteins absent from artificial tears; speeds closure of persistent epithelial defects.
Mechanism: Mimics the biochemical profile of natural tears to promote epithelial and nerve health. PMC+1
Platelet-rich plasma (PRP) eye drops (concentration varies, 6–8×/day)
Function: High platelet-derived growth factors (PDGF, TGF-β, EGF) to drive wound healing in stubborn defects.
Mechanism: Growth factor-rich plasma supports epithelial migration and stromal remodeling (protocols vary; not universally available).
Amniotic membrane extract eye drops (AMEED) (investigational/varies)
Function: Delivers soluble factors from amniotic tissue without placing a membrane.
Mechanism: Anti-inflammatory and pro-healing cytokines reduce scarring; availability and evidence vary by region.
RGTA® (heparan-sulfate mimetics, e.g., Cacicol) (where available)
Function: “Protects” endogenous growth factors within the wound by replacing degraded matrix binding sites.
Mechanism: Rebuilds extracellular matrix micro-niches so native growth factors can act longer; evidence is promising but region-specific.
Umbilical cord blood serum drops (special centers)
Function: Very high growth-factor content; used when AST/PRP are not possible.
Mechanism: Similar to AST/PRP but derived from screened donor cord blood; availability limited.

Note: Mesenchymal stem cell therapies and exosome drops are being studied but are not standard of care; they should be used only in clinical trials.

Surgeries

Lateral canthotomy and cantholysis (bedside decompression)
Why: Emergency treatment for retrobulbar hemorrhage causing vision-threatening pressure after an injection.
What happens: The outer corner of the eyelid is numbed and released to relieve pressure so blood can flow to the retina and optic nerve again—time-critical to save sight. NCBIEyeWiki
Primary globe repair (with or without pars plana vitrectomy)
Why: If a needle accidentally perforates the eye (globe penetration/perforation).
What happens: A retina/trauma surgeon repairs the entry site, treats internal bleeding or retinal tears, and may do vitrectomy to remove blood or treat detachment. PMC
Amniotic membrane transplantation (suture or ring device)
Why: Persistent corneal epithelial defects or neurotrophic ulcers not closing with drops alone.
What happens: A layer of amniotic tissue is placed on the cornea to act like a biologic dressing that speeds closure and reduces scarring.
Limbal stem cell transplantation (e.g., SLET or cultivated limbal epithelial transplantation)
Why: Limbal stem cell deficiency after severe surface toxicity.
What happens: Stem-cell–rich limbal tissue from the patient or a donor is transplanted to rebuild the corneal surface.
Strabismus or ptosis repair (select cases of myotoxic injury)
Why: Persistent double vision from muscle injury or droopy lid from levator damage after a block.
What happens: Eye-muscle surgery re-balances alignment; ptosis surgery tightens/advances the eyelid muscle.

Smart prevention steps

Never use topical anesthetic drops at home unless you are in a specific, time-limited protocol with an eye specialist. This single rule prevents most surface toxicity. PubMed
Use preservative-free diagnostic drops where possible to reduce additive toxicity with frequent procedures.
For injections, use the safest effective technique (e.g., sub-Tenon’s or carefully performed peribulbar) for high-risk eyes (very long, myopic, prior surgery). ScienceDirect
Choose appropriate needle length/angle and avoid pushing during eye movement; keep the patient coached and still.
Pre-procedure assessment of bleeding risk (anticoagulants, platelet disorders); plan accordingly.
Real-time monitoring after blocks so any swelling, pain, or vision change is caught early—especially in the first 24 hours. EyeWiki
Have a written “vision-threat triage” plan (IOP check, pupils, visual acuity) after blocks.
Ensure rescue tools are immediately available (tonometer, canthotomy set) and staff trained for fast decompression when needed. NCBIEyeWiki
Limit corneal exposure during procedures (keep the surface lubricated, avoid prolonged drying under microscope light).
Educate patients about what to report urgently (sudden pain, bulging, vision loss).

When to see a doctor

Seek immediate eye-care if, after anesthesia or an injection, you have any of the following: sudden decrease in vision, severe or escalating eye pain or pressure, a bulging eye, inability to open the eye due to swelling, new double vision, a pupil that looks different than before, dense bleeding under the skin around the eye, flashes/floaters or a curtain over vision, or a non-healing painful surface defect. With surface toxicity, worsening pain that briefly improves only after a numbing drop is a red flag—get urgent help. EyeWiki+1

What to eat—and what to avoid

Eat more of these

Protein-rich foods (fish, eggs, legumes, lean meats) to supply amino acids for tissue repair.
Vitamin-C–rich fruits/veg (citrus, kiwi, bell peppers) for collagen building.
Leafy greens and orange vegetables (spinach, kale, carrots, squash) for vitamin A precursors that help surface cells.
Omega-3 sources (fatty fish like salmon, sardines; flax/chia) to support tear film quality.
Water—regular, steady hydration to keep tears flowing.

Limit or avoid these

Tobacco (any form)—it slows healing and worsens dryness.
Excess alcohol, which dehydrates and delays repair.
Highly processed, high-glycemic foods that drive inflammation.
Very spicy or irritant fumes when your eye surface is raw (they can sting and provoke tearing).
Supplements that thin blood (e.g., high-dose fish oil, ginkgo) right before injections—only change with your doctor’s guidance.

Frequently Asked Questions

Can I use numbing drops at home for pain?
No. Repeated use can severely injure the cornea and cause non-healing ulcers. Use safer pain plans from your doctor. PubMed
How long does surface injury take to heal after stopping anesthetic drops?
Many small defects close in days to a couple of weeks with protection and lubrication. Severe cases or neurotrophic corneas can take longer and may need advanced treatments.
Is vision loss from an injection complication permanent?
It can be if blood flow or the optic nerve is injured for too long. Fast recognition and treatment, like urgent decompression for a retrobulbar hemorrhage, can save sight. NCBI
What is neurotrophic keratitis and why does it matter here?
It’s damage to the corneal nerves that makes the surface “numb and slow to heal.” Anesthetic toxicity and some injections can lead to it. Treatments like cenegermin or serum/PRP can help. ScienceDirectOXERVATE® (cenegermin-bkbj)
Will I need antibiotics if I have a surface defect?
Often yes, to prevent infection while the cornea heals. Your doctor will choose the right one and schedule.
Are steroids safe for these injuries?
Sometimes, in short, careful courses when infection is ruled out. In anesthetic-abuse keratopathy they are used cautiously because they can thin the cornea if overused. EyeWiki
Why do doctors use bandage contact lenses?
They protect the raw surface from blinking and reduce pain while cells grow back.
What is a lateral canthotomy/cantholysis?
A quick eyelid-corner release performed for vision-threatening pressure behind the eye. It’s done urgently to restore blood flow. NCBI
Are AST or PRP “real medicines”?
They’re biologic eye drops made from your own blood (AST/PRP). They contain natural growth factors that help the surface heal when standard drops are not enough. PMC
Does doxycycline help the cornea?
Yes, it can slow collagen breakdown by blocking enzymes (MMPs) and calm inflammation—use only if your doctor prescribes it. PMC
Can omega-3s cure dry, painful eyes?
They are supportive and may help some people, but results are mixed in studies. Use them as an adjunct, not a cure-all.
If I had an injection complication once, can I ever have another block?
Maybe—with a tailored plan. Your surgeon may use different techniques (e.g., sub-Tenon’s) and extra precautions to lower risk next time. ScienceDirect
What symptoms after anesthesia mean I should go to the ER now?
Sudden vision loss, severe pressure-like pain, a bulging eye, new double vision, or a black-looking pupil—do not wait. EyeWiki
Will I always need surgery for a non-healing defect?
No. Most heal with protective measures and drops; stubborn cases may benefit from amniotic membrane or biologic therapies before surgery.
Can I drive while healing?
Only if vision is safe in both eyes and light sensitivity is controlled. Ask your doctor—safety first.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.