A patient with which eye disease would be at greatest risk for retinal damage from hypotension during surgery?

A patient with which eye disease would be at greatest risk for retinal damage from hypotension during surgery?

• A. Strabismus
• B. Cataract
• C. Glaucoma
• D. Severe myopia

Answer: (C)

Ocular perfusion pressure, the pressure driving blood to the retina and optic nerve, falls with systemic hypotension. It’s roughly the mean arterial pressure minus the intraocular pressure. In glaucoma, the optic nerve head already has compromised blood flow regulation and existing damage, so a drop in perfusion during surgery can more readily cause retinal ischemia or optic neuropathy. The other conditions listed don’t inherently reduce retinal perfusion reserve in the face of hypotension the way glaucoma does. Therefore, glaucoma poses the greatest risk for retinal damage from perioperative hypotension.

Ocular perfusion pressure, the pressure driving blood to the retina and optic nerve, falls with systemic hypotension. It’s roughly the mean arterial pressure minus the intraocular pressure. In glaucoma, the optic nerve head already has compromised blood flow regulation and existing damage, so a drop in perfusion during surgery can more readily cause retinal ischemia or optic neuropathy. The other conditions listed don’t inherently reduce retinal perfusion reserve in the face of hypotension the way glaucoma does. Therefore, glaucoma poses the greatest risk for retinal damage from perioperative hypotension.