A 20 year old female, presented with history of swelling of right cheek since 2 weeks associated with fever and rash, blurring of vision in both eyes since 7 days which was sudden in onset and painless. Dilated fundoscopic examination of right eye showed disc edema with hyperemia with macular edema. Left eye showed disc edema with hyperemia, splinter hemorrhage on the disc and macular edema. This case posed a diagnostic challenge as clinically, it did not typically fit into the diagnosis of optic neuritis as the pupil reactions were normal, absence of afferent pupillary defect. However, there was rapid therapeutic response with intravenous injection of Dexamethasone, which improved the visual acuity from <1/60 to 6/6 in about a week.

Background: The effect of subtenon’s block with the usage of hyaluronidase in terms of analgesia and akinesia was studied in different sets of people and the results were not satisfactory in all of them .This study eliminates bias and mitigates the confounding factors such as age, sex, pain threshold of a person, anatomical variations when done on different individuals. Objectives: To evaluate the efficacy of subtenon’s anaesthesia with hyaluronidase in group A patients and without use of hyaluronidase in group B undergoing cataract surgery in terms of Globe and lid akinesia, analgesia, onset and duration of anaesthesia intra operatively and to document complications related to subtenon’s anaesthesia. Methods : 39 patients (78 eyes) who fulfil inclusion criteria were selected and subtenon’s anaesthesia with hyaluronidase during the first eye cataract surgery followed by other eye subtenon’s anaesthesia without hyaluronidase was adopted. the study is done at RLJH, Kolar in ophthalmology department which is a teritiary setting hospital. In both groups Analgesia was graded between 0-4 grades and globe akinesia was graded between 0-3 grades and lid movements was graded between 0-2 grades. Study design used is non randomized study. Results: Analgesia (p = 0.008), globe akinesia (p = 0.002)at 15 mins ,lid akinesia (p=0.027) at 10 mins were good in Group A and it was statistically significant. The rate of onset of akinesia, patient and surgeon satisfaction were better in case of Group A . Complications were equal in both the groups showing no role of hyaluronidase in the complications and relating them to subtenon’s. Conclusions: Hyaluronidase has shown better onset of akinesia, good intraoperative analgesia , good globe and lid akinesia. Keywords: Subtenon’s block , Hyaluronidase, Akinesia, Analgesia.