Suppressing the photic sneeze reflex with propofol during routine cataract surgery

Introduction: The photic sneeze reflex (PSR) occurs when sneezing is triggered by bright light, which poses a unique intraoperative challenge to ophthalmologists and increases potential for unintentional injury to the patient. In this case series, we report 3 patients whose intractable PSRs were extinguished by adjunctive intravenous propofol during cataract extraction surgery. Propofol may be useful in cases of intractable PSR. Patient and Clinical Findings: 3 patients without a history of prior ocular surgery presented for routine cataract extraction surgery for age-related cataracts. The patients demonstrated intractable PSR once exposed to the lights of a standard ophthalmic surgical microscope. Diagnosis, Intervention, and Outcomes: These patients demonstrated intractable sneezing when under direct surgical lighting. This presentation is consistent with a PSR. Patients were initially sedated with midazolam. Propofol was then added adjunctively, which successfully controlled the reflex and allowed for surgery to proceed as planned. Propofol is an anesthetic and sedative often used for ophthalmic procedures. Conclusions: Adjunctive intravenous propofol was used to successfully extinguish intractable PSRs during routine cataract surgery.