Skip to main content

Advertisement

SpringerLink
Log in

Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review

  • Case Report
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Background The enzyme hyaluronidase (HA) is an adjunctive in retrobulbar anaesthesia (RA) that is used during ophthalmic surgery to improve the efficacy and speed of nerve blocks. Although uncommon, HA has been shown to be a potential cause of allergic responses. Case reports We describe three patients who experienced an allergic reaction to HA following ocular surgery in our department and provide an extensive overview of the literature on HA in RA. Conclusions Although rare and mostly benign, allergy to HA should be included in the differential diagnosis when chemosis, proptosis and restriction of eye movements occur after parabulbar or retrobulbar anaesthesia. The authors feel that the beneficial effect of HA in small volumes of RA warrants its use despite this potential complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

HA:

Hyaluronidase

RA:

Retrobulbar anaesthesia

References

  1. Rowley SA, Hale JE, Finlay RD (2000) Sub-Tenon’s local anaesthesia: the effect of hyaluronidase. Br J Ophthalmol 84:435–436

    Article  CAS  PubMed  Google Scholar 

  2. Alwitry A, Chaudhary S, Gopee K, Butler TK, Holden R (2002) Effect of hyaluronidase on ocular motility in sub-Tenon’s anesthesia: randomized controlled trial. J Cataract Refract Surg 28:1420–1423

    Article  PubMed  Google Scholar 

  3. Afify AM, Stern M, Guntenhöner M, Stern R (1993) Purification and characterization of human serum hyaluronidase. Arch Biochem Biophys 305:434–441. doi:10.1006/abbi.1993.1443

    Article  CAS  PubMed  Google Scholar 

  4. Kempeneers R, Dralands L, Ceuppens J (1992) Hyaluronidase induced orbital pseudotumor as a complication of retrobulbar anesthesia. Bull Soc Belge Ophtalmol 243:159–166

    CAS  PubMed  Google Scholar 

  5. Quhill F, Bowling B, Packard RB (2004) Hyaluronidase allergy after peribulbar anesthesia with orbital inflammation. J Cataract Refract Surg 30:916–917. doi:10.1016/j.jcrs.2003.08.024

    Article  PubMed  Google Scholar 

  6. Eberhart AH, Weiler CR, Erie JC (2004) Angioedema related to the use of hyaluronidase in cataract surgery. Am J Ophthalmol 138:142–143. doi:10.1016/j.ajo.2004.02.035

    Article  PubMed  Google Scholar 

  7. Youssef Z, Pennefather PM, Watts MT (2005) Orbital cellulitis vs allergic reaction to hyaluronidase as the cause of periorbital oedema. Eye 19(6):691–692 (author reply 692). doi:10.1038/sj.eye.6701553

    Google Scholar 

  8. Ahluwalia HS, Lukaris A, Lane CM (2003) Delayed allergic reaction to hyaluronidase: a rare sequel to cataract surgery. Eye 17:263–266. doi:10.1038/sj.eye.6700243

    Article  CAS  PubMed  Google Scholar 

  9. Musa F, Srinivasan S, King CM, Kamal A (2006) Raised intraocular pressure and orbital inflammation: a rare IgE-mediated allergic reaction to sub-Tenon’s hyaluronidase. J Cataract Refract Surg 32:177–178. doi:10.1016/j.jcrs.2005.11.024

    Article  PubMed  Google Scholar 

  10. Kirby B, Butt A, Morrison AM, Beck MH (2001) Type I allergic reaction to hyaluronidase during ophthalmic surgery. Contact Dermatitis 44:52. doi:10.1034/j.1600-0536.2001.440107-19.x

    Article  CAS  PubMed  Google Scholar 

  11. Leibovitch I, Tamblyn D, Casson R, Selva D (2006) Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery. Graefes Arch Clin Exp Ophthalmol 244:944–949. doi:10.1007/s00417-005-0190-5

    Article  CAS  PubMed  Google Scholar 

  12. Ebo DG, Goossens S, Opsomer F, Bridts CH, Stevens WJ (2005) Flow-assisted diagnosis of anaphylaxis to hyaluronidase. Allergy 60:1333–1334. doi:10.1111/j.1398-9995.2005.00891.x

    Article  CAS  PubMed  Google Scholar 

  13. Szépfalusi Z, Nentwich I, Dobner M, Pillwein K, Urbanek R (1997) IgE-mediated allergic reaction to hyaluronidase in paediatric oncological patients. Eur J Pediatr 156:199–203. doi:10.1007/s004310050582

    Article  PubMed  Google Scholar 

  14. Kallio H, Paloheimo M, Maunuksela E (2000) Hyaluronidase as an adjuvant in bupivacaine–lidocaine mixture for retrobulbar/peribulbar block. Anesth Analg 91:934–937. doi:10.1097/00000539-200010000-00031

    Article  CAS  PubMed  Google Scholar 

  15. Guise P, Laurent S (1999) Sub-Tenon’s block: the effect of hyaluronidase on speed of onset and block quality. Anaesth Intensive Care 27:179–181

    CAS  PubMed  Google Scholar 

  16. Sarvela J, Nikki P (1992) Hyaluronidase improves regional anaesthesia with etidocaine. Can J Anaesth 39:920–924

    Article  CAS  PubMed  Google Scholar 

  17. Dempsey GA, Barret PJ, Kirby IJ (1997) Hyaluronidase and peribulbar block. Br J Anaesth 78:671–674

    CAS  PubMed  Google Scholar 

  18. Krohn J, Seland JH, Høvding G, Bertelsen T, Aasved H, Haugen OH (1993) Retrobulbar anesthesia with and without hyaluronidase in extracapsular cataract surgery. A prospective, randomized, double-blind study. Acta Ophthalmol (Copenh) 71:791–795

    Article  CAS  Google Scholar 

  19. Sarvela J, Nikki P (1992) Hyaluronidase improves regional anaesthesia with etidocaine. Can J Anaesth 39:920–924

    Article  CAS  PubMed  Google Scholar 

  20. Nicoll JMV, Treuren B, Arun Acharya P, Ahlen K, James M (1986) Retrobulbar anesthesia. The role of hyaluronidase. Anesth Analg 65:1324–1328. doi:10.1213/00000539-198612000-00013

    Article  CAS  PubMed  Google Scholar 

  21. Crawford M, Kerr W (1994) The effect of hyaluronidase on peribulbar block. Anaesthesia 49:907–908

    Article  CAS  PubMed  Google Scholar 

  22. Prosser DP, Rodney GE, Mian T, Jones HM, Khan MY (1996) Re-evaluation of hyaluronidase in peribulbar anaesthesia. Br J Ophthalmol 80:827–830. doi:10.1136/bjo.80.9.827

    Article  CAS  PubMed  Google Scholar 

  23. Bowman RJ, Newman DK, Richardson EC, Callear AB, Flanagan DW (1997) Is hyaluronidase helpful for peribulbar anaesthesia? Eye 11:385–388

    PubMed  Google Scholar 

  24. Schulenburg HE, Sri-Chandana C, Lyons G, Columb MO, McLure HA (2007) Hyaluronidase reduces local anaesthetic volumes for sub-Tenon’s anaesthesia. Br J Anaesth 99:717–720. doi:10.1093/bja/aem272

    Article  CAS  PubMed  Google Scholar 

  25. Escolano F, Pares N, Gonzalez I, Castillo J, Valero A, Bartolome B (2005) Allergic reaction to hyaluronidase in cataract surgery. Eur J Anaesthesiol 22:729–730. doi:10.1017/S0265021505251190

    Article  CAS  PubMed  Google Scholar 

  26. Nicholson G, Hall GM (2003) Allergic reaction to hyaluronidase after a peribulbar injection. Anaesthesia 58:814–815. doi:10.1046/j.1365-2044.2003.03295_18.x

    Article  CAS  PubMed  Google Scholar 

  27. Varma D, Metcalfe TW (2003) Orbital cellulitis after peribulbar anaesthesia for cataract surgery. Eye 17:105–107. doi:10.1038/sj.eye.6700238

    Article  CAS  PubMed  Google Scholar 

  28. Minning CA Jr (1994) Hyaluronidase allergy simulating expulsive choroidal hemorrhage. Arch Ophthal 112:585–586

    PubMed  Google Scholar 

  29. Taylor IS, Pollowitz JA (1984) A little known phenomenon: allergic reaction to hyaluronidase. Ophthalmology 91:1003

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Prof. Dr. Jan Ceuppens for his clinical expertise and Prof. Dr. Ilse Mombaerts for critically reading the manuscript.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, University Hospitals Leuven, Campus St Raphaël, Kapucijnenvoer 33, 3000, Leuven, Belgium

    L. Delaere, T. Zeyen, B. Foets, J. Van Calster & I. Stalmans

Authors
  1. L. Delaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Zeyen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Foets
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Van Calster
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Stalmans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Stalmans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Delaere, L., Zeyen, T., Foets, B. et al. Allergic reaction to hyaluronidase after retrobulbar anaesthesia: a case series and review. Int Ophthalmol 29, 521–528 (2009). https://doi.org/10.1007/s10792-008-9258-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-008-9258-7

Keywords

Search

Navigation