Ocular and Visual Complications Following Cardiac Surgery: A Scoping Review

Abstract Background Cardiac surgery carries a disproportionately elevated risk of perioperative ophthalmological complications compared with other surgical procedures. Despite growing recognition of ocular and visual complications in this setting, a comprehensive synthesis of their entire spectrum has been lacking. Objective To systematically identify, map, and characterize the full range of ocular and visual complications reported following cardiac surgery, including disorders affecting ophthalmic structures, ocular motility, or visual function. Methods This scoping review was conducted following the Joanna Briggs Institute methodology and reported according to the PRISMA-ScR recommendations. PubMed, Embase, and Web of Science were searched from inception through January 2025 for studies reporting ocular or visual complications directly associated with heart or great vessel surgery. Evidence was charted by complication type and synthesized descriptively. Results Our review included 115 studies, mostly case reports. The most frequently reported complications were ischemic optic neuropathy, retinal vascular occlusive disorders, cerebral visual impairment, pituitary apoplexy, midbrain ischemia, visual pseudohallucinations, Horner syndrome, endophthalmitis, supranuclear ocular motility disorders, and orbital hemorrhage. Less recognized potential complications included ocular hypotony, amaurosis fugax, chiasmal stroke, Miller Fisher syndrome, ocular ischemic syndrome, paracentral acute middle maculopathy, and retinal detachment. Based on case report data, patients were predominantly men and most often in their 6th or 7th decades of life, ischemic optic neuropathy accounted for the most events, and coronary artery bypass grafting was the most frequently implicated operation. Recurring perioperative associations with cardiopulmonary bypass, hemodynamic instability, embolic phenomena, anemia, and preexisting vascular comorbidities were observed across studies. Visual outcomes were variable, with many ischemic complications resulting in persistent deficits. Conclusions Ocular and visual complications after cardiac surgery constitute a broad, heterogeneous group of disorders that, albeit rare, may result in substantial morbidity. Clinical awareness, perioperative vigilance, and prompt multidisciplinary evaluation may facilitate early identification and timely management.