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 Table of Contents  
PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 3  |  Page : 798-799

Corneal block: A rare iatrogenic anesthetic complication


1 Departments of Cornea and Refractive Services, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
2 Vitreoretinal Services, Sankara Eye Hospital, Guntur, Andhra Pradesh, India
3 Department of Vitreo-Retinal Services, Sankara Eye Hospital, Guntur, Andhra Pradesh, India

Date of Submission02-Nov-2021
Date of Acceptance04-Feb-2022
Date of Web Publication16-Jul-2022

Correspondence Address:
Dr. Eswar Rao Sakare
Cornea and Refractive Services, Sankara Eye Hospital, Guntur - 522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2792_21

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  Abstract 


Keywords: Anesthetic Complication, corneal anesthesia, corneal injection, intrastromal anesthetic


How to cite this article:
Potti S, Kanakamedala A, Sakare ER, Sodum NR. Corneal block: A rare iatrogenic anesthetic complication. Indian J Ophthalmol Case Rep 2022;2:798-9

How to cite this URL:
Potti S, Kanakamedala A, Sakare ER, Sodum NR. Corneal block: A rare iatrogenic anesthetic complication. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 13];2:798-9. Available from: https://www.ijoreports.in/text.asp?2022/2/3/798/351152



A 65-year-old patient undergoing cataract surgery was given peribulbar anesthesia. For additional anesthesia, Van Lint technique was tried; patient moved his head due to pain, leading to accidental injection of around 0.1 ml of 2% lidocaine + hyaluronidase mixture into the cornea, resulting in corneal edema. On examination, the patient had diffuse cornea edema with Descemet's membrane folds and localized segmental bubbles in anterior stroma [Figure 1]a. The anterior chamber was well formed, Siedel's test was negative, and no conjunctival trauma was noted. He was advised 0.3% ciprofloxacin eye ointment twice a day prophylactically; eye patching was done and surgery was deferred. Next day, corneal edema reduced with the presence of few Descemet's membrane folds [Figure 1]b. On anterior segment coherence tomography, a fine track in the mid-stroma, representing entry of the needle, was present and no Descemet's membrane detachment noted [Figure 2]. On the third day, cornea was clear without any Descemet's membrane folds; fine hazy line in the temporal area representing needle track was noted [Figure 3]. Specular microscopy could not be retrieved before the injection, but showed normal results after this complication [Figure 4]. Patient felt comfortable and wanted to undergo surgery, so cataract surgery was performed.
Figure 1: (a) On the day of accidental intrastromal injection of the anesthetic drug, which caused stromal edema and striate keratopathy. (b) On the next day, corneal edema resolved and the cornea appeared relatively clear

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Figure 2: Anterior segment optical coherence tomography showing fine line of hyperreflectivity, suggestive of needle track (balck arrow)

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Figure 3: On the next day, fine hazy line (white arrow) appeared on the temporal side of cornea, suggestive of needle track

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Figure 4: Specular microscopy after resolution of corneal edema had normal results

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  Discussion Top


Ghosh et al.[1] reported a similar scenario while doing entropion surgery; subconjunctival hemorrhage and corneal edema were noted, which resolved on usage of hyperosmotic agents, cycloplegics, antibiotics, and lubricants over a period of 1 week. As mentioned by Anderson et al.[2] and Schellini et al.[3] in their studies, lidocaine might have washed out of the cornea by diffusion through epithelium and endothelium without causing much damage to cornea.

Thus, if accidental injection of a very small amount of anesthetic drug occurs into the cornea, it will resolve within 2–3 days.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ghosh S, Mukhopadhyay S, Mukhopadhyay S. Inadvertent intracorneal injection of local anesthetic during lid surgery. Cornea 2010;29:701-2.  Back to cited text no. 1
    
2.
Anderson NJ, Woods WD, Kim T, Rudnick DE, Henry M, Edelhauser F. Intracameral anesthesia in vitro iris and corneal uptake and washout of 1% lidocaine hydrochloride. Arch Ophthalmol 1999;117:225-32.  Back to cited text no. 2
    
3.
Schellini SA, Creppe MC, Gregório EA, Padovani CR. Lidocaine effects on corneal endothelial cell ultrastructure. Vet Ophthalmol 2007;10:239-44.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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