Hyaluronidase toxicity: a possible cause of postoperative periorbital inflammation.
BACKGROUND
Periorbital inflammation following regional anaesthesia is commonly attributed to hyaluronidase allergy. This case series suggests an alternative explanation in some patients.


METHODS
Retrospective case series.


METHODS
Seven patients presenting with postoperative non-infectious periorbital inflammation following peribulbar or sub-tenons anaesthesia, presenting at four different institutions, are described.


METHODS
Data on patient demographics, operative data, clinical presentation, treatment and allergy testing were collected among the four institutions.


METHODS
Response to treatment and allergy testing were noted among the patients included in this study.


RESULTS
Seven patients (five female) underwent uneventful phacoemulsification under a peribulbar or sub-tenon's block, all including hyaluronidase with concentrations ranging 50-250 IU/mL. The onset of inflammatory symptoms and signs varied from 12 h to 3 days after the surgery. The most common form of presentation was lid swelling and chemosis. Patients were treated with oral corticosteroids, with good clinical response. Four patients underwent skin prick and intradermal testing to the local anaesthetic used, and to the suspect and a control hyaluronidase batch. The results were all negative, excluding allergy as the aetiology of this toxic periorbital syndrome, in at least these four patients.


CONCLUSIONS
Hyaluronidase toxicity, potentially related to concentration of hyaluronidase, may be a cause of postoperative periorbital inflammation after cataract surgery, rather than hypersensitivity.
Department of Ophthalmology, The Queen Elizabeth Hospital, Australia.
Katherine
K
Zamora-Alejo
Sacha
S
Moore
Brian
B
Leatherbarrow
Jonathan H
JH
Norris
Damien B
DB
Lake
Raman
R
Malhotra
Dinesh
D
Selva
Michael
M
Goggin
D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000627:therapeutic use; D002386:Cataract; D004342:Drug Hypersensitivity / Q000175:diagnosis; D005141:Eyelid Diseases / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000009:adverse effects*; D007249:Inflammation / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D009916:Orbital Diseases / Q000139:chemically induced* / Q000175:diagnosis; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D012882:Skin Tests
D000779:Anesthetics, Local; D006821:Hyaluronoglucosaminidase