Butler FK Jr, Hagan C, Murphy-Lavoie H, et al.
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, In.... Date of publication 2008 Sep 1;volume 35(5):333-87.
1. Undersea Hyperb Med. 2008 Sep-Oct;35(5):333-87.
Hyperbaric oxygen therapy and the eye.
Butler FK Jr(1), Hagan C, Murphy-Lavoie H.
Author information:
(1)Navy Medical Lessons Learned Center, Naval Operational Medicine Institute,
Pensacola, FL, USA.
Comment in
Undersea Hyperb Med. 2008 Sep-Oct;35(5):331-2.
Hyperbaric oxygen therapy (HBOT) is a primary or adjunctive therapy for a variety
of medical disorders including some involving the eye. This paper is the first
comprehensive review of HBOT for ocular indications. The authors recommend the
following as ocular indications for HBOT: decompression sickness or arterial gas
embolism with visual signs or symptoms, central retinal artery occlusion, ocular
and periocular gas gangrene, cerebro-rhino-orbital mucormycosis, periocular
necrotizing fasciitis, carbon monoxide poisoning with visual sequelae, radiation
optic neuropathy, radiation or mitomycin C-induced scleral necrosis, and
periorbital reconstructive surgery. Other ocular disorders that may benefit from
HBOT include selected cases of ischemic optic neuropathy, ischemic central
retinal vein occlusion, branch retinal artery occlusion with central vision loss,
ischemic branch retinal vein occlusion, cystoid macular edema associated with
retinal venous occlusion, post-surgical inflammation, or intrinsic inflammatory
disorders, periocular brown recluse spider envenomation, ocular quinine toxicity,
Purtscher's retinopathy, radiation retinopathy, anterior segment ischemia,
retinal detachment in sickle cell disease, refractory actinomycotiC lacrimal
canaliculitis, pyoderma gangrenosum of the orbit and refractory pseudomonas
keratitis. Visual function should be monitored as clinically indicated before,
during, and after therapy when HBOT is undertaken to treat vision loss. Visual
acuity alone is not an adequate measure of visual function to monitor the
efficacy of HBOT in this setting. Ocular examinations should also include
automated perimetry to evaluate the central 30 degrees of visual field at
appropriate intervals. Interpretation of the literature on the efficacy of HBOT
in treating ocular disorders is complicated by several factors: frequent failure
to include visual field examination as an outcome measure, failure to adequately
address the interval from symptom onset to initiation of HBOT, and lack of
evidence for optimal treatment regimens for essentially all ocular indications.
Because some ocular disorders require rapid administration of HBOT to restore
vision, patients with acute vision loss should be considered emergent when they
present. Visual acuity should be checked immediately, including vision with
pinhole correction. If the patient meets the criteria for emergent HBOT outlined
in the paper, normobaric oxygen should be started at the highest inspired oxygen
fraction possible until arrangements can be made for HBOT.
PMID: 19024664 [Indexed for MEDLINE]
