Periocular inflammation after retrobulbar chlorpromazine (thorazine) injection.
OBJECTIVE
Retrobulbar chlorpromazine injection is a relatively recently described method of pain control in nonseeing eyes. This report illustrates severe sterile inflammation as a potential complication.


METHODS
In this university-based, retrospective, small case series, we reviewed the records of 2 female patients and 1 male patient (ages, 13 to 89 years) who developed severe inflammation after retrobulbar chlorpromazine injection.


RESULTS
Three patients had development of severe periocular edema after retrobulbar chlorpromazine injection. Two had development of chemosis, limited extraocular motility, proptosis, and incomplete eyelid closure, necessitating temporary tarsorrhaphy. The third patient had development of facial edema involving the ipsilateral eyelids, forehead, and cheek. Strikingly, it extended to the contralateral face. All 3 patients denied discomfort. In each case, swelling was first noted the day after injection and progressed for 1 week. All were treated with topical lubrication and two with temporary tarsorrhaphy. Resolution occurred within 3 weeks in each case.


CONCLUSIONS
Severe periocular inflammation can result from retrobulbar chlorpromazine injection and may manifest as chemosis, proptosis, limited ocular motility, and facial swelling that may extend well beyond the eyelids. Awareness of this potential adverse reaction is important both for patient counseling before injection and subsequent treatment. Specifically, a sterile inflammatory response should be differentiated from infection to avoid inappropriate therapy.
McCulley
Timothy J
TJ
University of California San Francisco, Department of Ophthalmology, San Francisco, California, USA. mcculley@stanford.edu
Kersten
Robert C
RC
D000293:Adolescent; D000369:Aged, 80 and over; D001762:Blepharitis / Q000139:chemically induced* / Q000503:physiopathology; D002746:Chlorpromazine / Q000009:adverse effects*; D003231:Conjunctivitis / Q000139:chemically induced* / Q000503:physiopathology; D018492:Dopamine Antagonists / Q000009:adverse effects*; D004487:Edema / Q000139:chemically induced / Q000503:physiopathology; D005094:Exophthalmos / Q000139:chemically induced / Q000503:physiopathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000139:chemically induced / Q000503:physiopathology; D007267:Injections; D008297:Male; D008875:Middle Aged; D009915:Orbit; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies
D018492:Dopamine Antagonists; D002746:Chlorpromazine