Displacement of crystalline lens into the sub-conjunctival space following periocular anesthesia

Abstract

A 65-year-old female presented with loss of vision and a mass in her right eye after periocular anaesthesia for cataract surgery in a camp. She was found to have a nasal subconjunctival mass, which was confirmed to contain the crystalline lens after surgical exploration, along with a superior perilimbal suspected scleral rupture. There was accompanying vitreous haemorrhage, retinal detachment and subretinal haemorrhage that was managed by pars plana vitrectomy. Post operatively, she achieved a best corrected visual acuity of 20/80 that was maintained till 6 months follow up. Globe rupture and subconjunctival lens extrusion in the setting of inadvertent globe penetration during periocular anesthesia is a rare complication. In the absence of medical records pertaining to the primary event, this clinical presentation posed a diagnostic challenge. Timely and appropriate management led to an acceptable visual and anatomical outcome in this unfortunate and devastating scenario.