Which of the following represents the orbital complications associated with a V2 block?

• A. CN VI block
• B. Retroorbital block
• C. Optic nerve block
• D. All of the above

Answer: (D)

When a V2 block is performed, the injection is near the pterygopalatine fossa and the orbit is in close proximity through the inferior orbital fissure. If the anesthetic spreads posteriorly or is deposited with too much volume or depth, it can enter the orbit and affect neural structures there. The abducens nerve (CN VI) travels into the orbit and supplies the lateral rectus; diffusion of anesthesia to this area can temporarily impair the nerve, leading to diplopia. The optic nerve can also be involved if the agent reaches the intraconal space or optic canal, causing transient visual disturbances or vision loss. Direct deposition behind the orbital wall (retroorbital spread) is another way the orbit can be affected. Because a V2 block has the potential to cause all of these orbital issues, the best answer is that all of the above are possible complications. To minimize risk, use careful technique, limit volume, and aspirate before injecting.