Rare Ocular Complication After Prone Position Surgery: Bilateral Subconjunctival Hemorrhage Following Endoscopic Lumbar Discectomy

Shin-Lin Chiu,1– 3 Chiu-Liang Chen4,5 1Department of Ophthalmology, Changhua Christian Hospital, Taiwan; 2Department of Optometry, Da-Yeh University, Changhua, Taiwan; 3Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; 4Department of Orthopedics, Changhua Christian Hospital, Taiwan; 5Department of Nursing, Hungkuang University, Taichung, TaiwanCorrespondence: Chiu-Liang Chen, Department of Orthopedics, Changhua Christian Hospital, Taiwan, No. 135, Nanxiao St, Changhua, 50073, Taiwan, Email [email protected]; [email protected]: Subconjunctival hemorrhage (SCH) is a rare complication in spinal surgery and is even more uncommon in endoscopic procedures, which are typically of short duration. We report the case of a 32-year-old male who developed bilateral SCH after an uneventful L4–L5 lumbar endoscopic discectomy performed under general anesthesia. The patient had a history of well-controlled hypertension and was not on anticoagulant therapy. The surgery lasted approximately 50 minutes, with appropriate head protection and smooth airway management. On the first postoperative day, bilateral SCH was observed without pain or visual disturbance. The hemorrhages resolved spontaneously within two weeks without complications. Although the exact mechanism remains unclear, contributing factors may include prone positioning, venous congestion, hemodynamic shifts, and hypertension-related vascular fragility. This case highlights the importance of recognizing subconjunctival hemorrhage as a rare but benign complication of prone spinal surgery, and suggests that patient reassurance and awareness are essential.Plain Language Summary: This report describes a rare eye condition that occurred after an endoscopic spine surgery. A 32-year-old man underwent an endoscopic lumbar discectomy, a common procedure used to treat a herniated disc in the lower back. The surgery was short, lasted only 50 minutes, and went smoothly under general anesthesia. Postoperatively, the patient was found to have bleeding in both eyes, known as bilateral subconjunctival hemorrhage. Although this looked concerning, it caused no pain or vision problems and resolved on its own within two weeks. This type of bleeding after spine surgery is very rare, and there are no previous reports of it happening after endoscopic spine surgery. The exact cause is unknown, but it may be related to body positioning during surgery, increased pressure in the veins, or the patient’s history of high blood pressure. This case shows that even with short and low-risk procedures, rare but harmless complications can happen, and awareness of such events can help doctors reassure patients and avoid unnecessary alarm.Keywords: intraocular pressure fluctuation, perioperative hemodynamics, postoperative eye finding, venous congestion, microvascular rupture