ANESTHESIA FOR THE EYE AND SPECIAL POPULATIONS PRACTICE QUESTIONS AND ANSWERS | 2026 UPDATE | GRADED A +.
What is the standard range for intraocular pressure? ✔️12-20
Intraocular pressure is determine by what 3 things? ✔️Scleral and corneal wall compliance
Intraocular blood and aqueous humor volume
External compression and periorbital structures
State whether the following anesthetic drugs will increase, decrease, or have no change on IOP.
Succinylcholine
Rocuronium
Ketamine
Volatiles ✔️Succinylcholine - increase by ~9mmHg for ~7min.
Rocuronium - no change
Ketamine - unknown (nystagmus related effects)
Volatiles - dose-dependent DECREASE
Which of the following will have the systemic effect of diuresis and hypokalemic metabolic acidosis?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️A) Acetazolamide
_____ increases the effects of succinylcholine. It's potential influence can last 3-7 weeks and additionally carries an increased risk of
bronchospasm and bradycardia?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️B) Echothiophate
This decreases aqueous solution production and has an increased risk of bronchospasm and atropine resistant bradycardia?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️C) Timolol
,What is the toxic dose of phenylephrine? ✔️10mg IV
Systemic effects of acetazolamide include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️A) Diuresis
B) Hypokalemic metabolic acidosis
Systemic effects of echothiophate include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
Systemic effects of timolol include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️D) Increased risk of bronchospasm
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade
What anticolinergic should you want to have on hand during pediatric strabismus surgery? ✔️Atropine
What is the MOST important pre-operative assessment prior to eye surgery? ✔️Correct eye
, What are your primary anesthesia goals for eye surgery? ✔️Safety
Analgesia
Akinesia
Control of IOP
Avoidance of OCR
Avoidance of drug interactions
PONV prophylaxis
Intraconal blocks which require an additional facial block are: (Retrobulbar/Peribulbar) ✔️Retrobulbar
Blocks which direct the needle toward the apex of the orbit are: (Retrobulbar/Peribulbar) ✔️Peribulbar
A 45-year-old woman presents to the hospital for a scheduled corneal transplant. The patient reports a medical history of myopia,
hypertension, and obesity. She denies cardiovascular symptoms and does not bring any lab results to review. She is currently on
losartan/hydrochlorothiazide. A regional anesthesia technique is planned that has 2 sites of insertion. The first is located at the inferotemporal
rim, and the second is at the medial canthus. After appropriate monitoring and antiseptic preparation, a 25 mm needle is used to insert
lidocaine 2% and bupivacaine 0.5% 1 to 1 mixture at the inferotemporal quadrant parallel to the floor of the orbit. Once the equator line of the
ocular globe is crossed, some resistance is felt, and the patient screams out in pain. The needle is reoriented more laterally, and 7 mL of local
anesthetic is infiltrated. The second puncture is performed without interruptions, and 4 mL of loc ✔️D.
Checking the axial length of the ocular globe before surgery
Sthaphylomas and an axial length of more than 26 mm are considered risk factors for ocular globe injury when performing an ocular regional
anesthesia technique
Myopia increases the axial ocular length and the presence of staphyloma
It is essential to check all these factors during the preoperative visit for better decision-making about the anesthetic technique
The ocular globe injury has been described with the peribulbar and the retrobulbar blocks. This case describes a peribulbar block. Performing
this block with a 25 mm needle is considered a safe practice. Checking the intraocular pressure is essential for making decisions about the
anesthetic technique to be performed. However, it is not related to the ocular globe injury
A 63-year-old man is brought to the perioperative area for a corneal transplant of his left eye. The surgeon requests a block that will provide
maximum ocular akinesia. The risk of which of the following complications is most likely to be increased with this block?
A.
Intravascular injection
What is the standard range for intraocular pressure? ✔️12-20
Intraocular pressure is determine by what 3 things? ✔️Scleral and corneal wall compliance
Intraocular blood and aqueous humor volume
External compression and periorbital structures
State whether the following anesthetic drugs will increase, decrease, or have no change on IOP.
Succinylcholine
Rocuronium
Ketamine
Volatiles ✔️Succinylcholine - increase by ~9mmHg for ~7min.
Rocuronium - no change
Ketamine - unknown (nystagmus related effects)
Volatiles - dose-dependent DECREASE
Which of the following will have the systemic effect of diuresis and hypokalemic metabolic acidosis?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️A) Acetazolamide
_____ increases the effects of succinylcholine. It's potential influence can last 3-7 weeks and additionally carries an increased risk of
bronchospasm and bradycardia?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️B) Echothiophate
This decreases aqueous solution production and has an increased risk of bronchospasm and atropine resistant bradycardia?
A) Acetazolamide
B) Echothiophate
C) Timolol
D) Phenylephrine ✔️C) Timolol
,What is the toxic dose of phenylephrine? ✔️10mg IV
Systemic effects of acetazolamide include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️A) Diuresis
B) Hypokalemic metabolic acidosis
Systemic effects of echothiophate include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
Systemic effects of timolol include:
Select all that apply.
A) Diuresis
B) Hypokalemic metabolic acidosis
C) Synergistic effects with succinylcholine
D) Increased risk of bronchospasm
E) Increased risk of bradycardia
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade ✔️D) Increased risk of bronchospasm
F) Atropine-resistant bradycardia
G) Non-selective beta-blockade
What anticolinergic should you want to have on hand during pediatric strabismus surgery? ✔️Atropine
What is the MOST important pre-operative assessment prior to eye surgery? ✔️Correct eye
, What are your primary anesthesia goals for eye surgery? ✔️Safety
Analgesia
Akinesia
Control of IOP
Avoidance of OCR
Avoidance of drug interactions
PONV prophylaxis
Intraconal blocks which require an additional facial block are: (Retrobulbar/Peribulbar) ✔️Retrobulbar
Blocks which direct the needle toward the apex of the orbit are: (Retrobulbar/Peribulbar) ✔️Peribulbar
A 45-year-old woman presents to the hospital for a scheduled corneal transplant. The patient reports a medical history of myopia,
hypertension, and obesity. She denies cardiovascular symptoms and does not bring any lab results to review. She is currently on
losartan/hydrochlorothiazide. A regional anesthesia technique is planned that has 2 sites of insertion. The first is located at the inferotemporal
rim, and the second is at the medial canthus. After appropriate monitoring and antiseptic preparation, a 25 mm needle is used to insert
lidocaine 2% and bupivacaine 0.5% 1 to 1 mixture at the inferotemporal quadrant parallel to the floor of the orbit. Once the equator line of the
ocular globe is crossed, some resistance is felt, and the patient screams out in pain. The needle is reoriented more laterally, and 7 mL of local
anesthetic is infiltrated. The second puncture is performed without interruptions, and 4 mL of loc ✔️D.
Checking the axial length of the ocular globe before surgery
Sthaphylomas and an axial length of more than 26 mm are considered risk factors for ocular globe injury when performing an ocular regional
anesthesia technique
Myopia increases the axial ocular length and the presence of staphyloma
It is essential to check all these factors during the preoperative visit for better decision-making about the anesthetic technique
The ocular globe injury has been described with the peribulbar and the retrobulbar blocks. This case describes a peribulbar block. Performing
this block with a 25 mm needle is considered a safe practice. Checking the intraocular pressure is essential for making decisions about the
anesthetic technique to be performed. However, it is not related to the ocular globe injury
A 63-year-old man is brought to the perioperative area for a corneal transplant of his left eye. The surgeon requests a block that will provide
maximum ocular akinesia. The risk of which of the following complications is most likely to be increased with this block?
A.
Intravascular injection
