Intraoperative Cardiovascular Instability in a Child Following Instillation of Phenylephrine Eye Drops

Introduction: The use of topical mydriatics is well described in ophthalmic surgery, one of these being phenylephrine eye drops which are available in 1%, 2.5% and 10% solutions. They are classically used to improve operating conditions but there have been recurrent concerns regarding serious adverse reactions as a direct consequence of systemic absorption. Case Reports: We present the case of a 10-year-old boy who presented for eyelid laceration repair and examination under general anaesthesia of the eye, after a severe dog bite injury. Shortly after instillation of 10% phenylephrine eye drops, the anaesthetist noticed a sudden bradycardia associated with profound hypertension. Surgery was temporarily stopped, volatile anaesthetic reduced and atropine boluses administered. Within minutes, blood pressure and heart rate normalized. The administration of the eye drops was determined to be the cause of this haemodynamic instability. Conclusion: A brief literature review has enabled us to raise awareness within our department regarding this important safety concern in paediatric ophthalmic surgery, in addition to exploring management options in the case of inadvertent intravascular absorption.