Hyaluronidase sensitivity: Our experience.

Sir,

With great interest, we read the article entitled,[1] “Rajalakshmi AR, Kumar MA. Hyaluronidase hypersensitivity: A rare complication of peribulbar block. Indian J Ophthalmology 2016;64:160-2.” We would like to share our experience of a similar case who was planned for a cataract surgery at our center.

Our patient was a 54-year-old female who had undergone an uneventful left eye phacoemulsification with intraocular lens (IOL) implantation under peribulbar anesthesia 1 month before. She was planned for the right eye phacoemulsification under peribulbar anesthesia. She did not have any relevant systemic history.

Lignocaine sensitivity was carried out 1 day before surgery with no hypersensitivity reaction.

On the day of surgery, she was given a peribulbar block (5 ml of 2% lignocaine + 2 ml of 0.5% bupivacaine + 1500 IU of hyaluronidase mixed in bupivacaine vial) with a 23-gauge needle in the inferotemporal orbit. She underwent an uneventful phacoemulsification with IOL implantation. Immediately after the surgery, she was noted to have lid edema with conjunctival chemosis and mild proptosis in both eyes [Fig. 1].

Figure 1

Immediate postoperative photo

She was managed with intravenous dexamethasone and pheniramine maleate and cold compresses. She was discharged on oral steroids and oral pheniramine with topical steroids. When reviewed on the next day, she was symptomatically better with mild decrease in lid edema and chemosis. Oral and topical medicines were continued, and the patient was reviewed after 5 Days [Fig. 2]. On examination, there was no lid edema or chemosis. Oral steroids were tapered, and the patient was asked to follow up after 2 weeks.

Figure 2

Photo after 5 days

Various case reports have been published on hyaluronidase sensitivity. They have shown immediate, early, intermediate, and delayed reactions to hyaluronidase.[2] Our patient fits into the criteria of immediate hypersensitivity which was well managed. Thus, we also emphasize that this rare complication of peribulbar block should be kept in mind when we suspect peribulbar hemorrhage.

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Conflicts of interest

There are no conflicts of interest.