Hyaluronidase hypersensitivity: A rare complication of peribulbar block

Abstract

Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight-threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.

Does the addition of hyaluronidase improve the quality of peribulbar anesthesia in cataract surgery? – A randomized double blinded study

“…Adverse events attributed to hyaluronidase include an increase in intraocular pressure, optic disc hemorrhage, exophthalmos, blindness and hypersensitivity reactions 26, 27. Hyaluronidase is believed to have a role in massive increase in capillary permeability seen in anaphylactic reactions and caution is advised in atopic individuals 28 .…”

Hyaluronidase injection for improved tissue dissection in Baerveldt tube surgery

“…Limitations of our technique include possible allergy to hyaluronidase, which is very rare (8, 9), and would be discovered during the peribulbar block usage of the enzyme prior to the surgical procedure. Our experience with this technique and long-term follow-up of patients did not reveal other adverse events when compared with the standard techniques often used in ophthalmic practice.…”

The Application and Usage of Anesthetics in the Surgical Treatment of Orbital Cellulitis

“…In order to perform the surgery for orbital cellulitis, a combination of anaesthetics are generally given to patients to reduce the pain that they may experience. The data reported in Table 1 suggests that physicians usually decide to inject the anesthetics into the patient's sub-Tenon space or their periorbital bulbar region [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. This is most likely because these sites are usually closest to the site of infection.…”