Severe orbital hematoma with third eyelid swelling and prolapse following a blind maxillary nerve block in a horse

A 20-year-old quarter horse gelding was presented for routine dental examination. Periodontal disease and luxation of tooth 108 was diagnosed and oral extraction was planned. After an unsuccessful blind maxillary nerve block, it was elected to perform the procedure under total intravenous anesthesia. Following recovery, a focal superficial corneal ulcer, severe retrobulbar swelling, mild exophthalmos, and marked swelling and prolapse of the third eyelid (nictitating membrane) were observed. Clinical signs persisted beyond 48 h despite the use of systemic anti-inflammatories and topical ocular anti-inflammatories and antibiotics. A temporary tarsorrhaphy was subsequently done at 48 h and the horse was discharged after 5 d of hospitalization and regression of clinical signs. Although it is very useful for easing dental extractions, the blind maxillary nerve block is associated with potential complications due to inadvertent vascular puncture. This case report describes a rare complication of prolapse of the third eyelid in a horse after a maxillary nerve block and successful treatment with a temporary tarsorrhaphy.Key clinical message:This case report explains how nictitating membrane swelling and prolapse can occur following a blind maxillary nerve block in the horse and describes treatment with a temporary tarsorrhaphy.