Anterior Ischemic Optic Neuropathy After Dental Extraction: Comment

I enjoyed reading the recent case report of by Kravitz and Foroozan, entitled 'Anterior ischemic optic neuropathy after dental extraction' (1). The report documented a case of a 19-year-old woman who developed a nonarteritic anterior ischemic optic neuropathy (NAION) after an otherwise uneventful dental extraction using local anesthetic and intravenous sedation (5-mg midazolam, 25-mg ketamine, and 60-mg propofol). Although the authors concluded that they could not be certain as to the etiology of the NAION; they hypothesized that the effects of lidocaine used as a local anesthetic and the possibility of local dental debris impaired blood flow to the optic nerve. The authors discount the possibility of local anesthetic agents acting on the cardiovascular system because of an absence of change in preprocedure and postprocedure blood pressure. The authors did not comment on the potential effect of intravenous anesthetics.