What factor significantly contributes to vitreous herniation during anesthesia induction in patients with eye injuries?

Vitreous herniation refers to the displacement of the vitreous gel in the eye, which can occur during certain movements or pressures applied to the eye. During anesthesia induction, factors that can increase intraocular pressure, such as coughing, straining, and bucking, play a significant role in contributing to this condition.

When a patient coughs or strains, there is an abrupt increase in intrathoracic and intra-abdominal pressure, which can subsequently elevate the intraocular pressure. This sudden spike can force the vitreous humor to push through any weak points or defects in the eye, particularly in cases of injury where the structural integrity of the eye is compromised.

In contrast, administering a neuromuscular blocker like rocuronium does not inherently cause changes in eye pressure. While face mask pressure might theoretically create some pressure on the eyes, it is less likely to result in significant herniation compared to the actions associated with coughing or straining. Initiating hyperventilation could lead to changes in carbon dioxide levels and blood pH, but it does not directly increase intraocular pressure in the same way as the physical actions of straining or coughing would.

Thus, the act of coughing, straining, and bucking during