Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery

Abstract

Although uncommon, allergy to peribulbar hyaluronidase injected during cataract surgery should be considered in the differential diagnosis of patients who present with acute post-operative orbital signs and symptoms.

Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review

“…Skin allergy testing is the most specific way to make the diagnosis of a HA hypersensitivity reaction [4]. Intradermal and skin prick testing are common methods used for determining the drug responsible for the allergic reaction [8,11]. The negative prick test of our second patient excludes an immediate IgE-mediated hypersensitivity, which is consistent with the late onset of clinical features.…”

“…An intradermal skin test can be done when the skin prick test results are unclear. Patch and scratch tests remain negative in this case [9,11].…”

“…In all cases, the cornea and the anterior chamber are clear, and the fundus is normal. There is the occasional loss of vision because of compression of the optic nerve or elevation of intraocular pressure due to increased venous pressure [4,11]. Patients with non-immediate reactions are generally not febrile and are in a good systemic condition, while those with an immediate reaction without previous RA and, thus, type I hypersensitivity, do show general symptoms (see Table 1).…”

Eyelid Malposition After Cataract and Refractive Surgery

“…18 The addition of hyaluronidase could also potentially increase the availability of the anesthetic and potentiate myotoxicity, but this has not been formally evaluated. It is also important to note the risk of hyaluronidase allergy, which has been described as a rare cause of acute orbital inflammatory symptoms after cataract surgery 24 However, in contrast to the above data, a study by Alpar 17 suggests that the type of solution injected is not a factor in postoperative ptosis. 7,17 Eyelid edema or hematoma formation postoperatively typically induces transient mechanical ptosis.…”

Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances

“…Given the frequent use, especially in ophthalmology, reports about intolerance are rare [69,70,71,72,73,74,75,76,77]. The most frequently reported adverse effects have been unspecific local injection site reactions [78].…”