3 General: Clinical Overview

Loss of vision and/or double vision is a devastating complication of ocular and periocular surgery and disease. Often, the patient fails to make a complete recovery once this ensues. This can be a life-changing event for the individual, and even small amounts of visual impairment can lead to loss of normal functioning, with major consequences on activities of daily living and employment. If the loss is secondary to surgery, the physician is likewise impacted emotionally and often legally. Needless to say, such problems should be recognized and handled as promptly as possible, enlisting the help of other specialties if needed.

In keeping with the old axiom that “An ounce of prevention is worth a pound of cure,” I always include “loss of vision, double vision, and need for further surgery” on my surgical consents for both major and minor procedures. Additionally, I verbally stress these potential risks to the patient. Patients will often display a significant degree of surprise when I mention this since they usually do not consider that these major complications can occur. They are usually reassured upon learning that these are indeed rare events and that I will do everything possible to mitigate the risks of the surgery. In 34 years of practice, I have had only one patient change his or her mind at the time of surgery because of this. We also discuss these complications at the time of the initial office visit to be as certain as possible that the patient is fully informed.

The following chapters will discuss these events and their management.