The danger of air injection into the anterior chamber following cataract extraction is emphasized in light of the current trend toward performing surgery on a dehydrated eye. It is especially hazardous when an osmotic agent is used preoperatively to induce surgical hypotonia. It is possible to inject a considerable amount of air into such a globe. With resumption of normal fluid volume, the air may be severely compressed or move into the posterior chamber, giving rise to pupillary block.
Two cases are presented in which orally administered glycerin was used preoperatively and an extremely soft globe was achieved prior to the cataract incision. Following the delivery of the lens, air was inadvertently drawn into the anterior chamber. This resulted in pupillary block glaucoma which responded in one case to intravenously administered mannitol and in the other to glycerin given orally.
JAFFE NS, LIGHT DS. The Danger of Air Pupillary Block Glaucoma in Cataract Surgery With Osmotic Hypotonia. Arch Ophthalmol. 1966;76(5):633-634. doi:10.1001/archopht.1966.03850010635002