Sever inadvertent globe perforation during supplemental peribulbar anesthesia injection

Abstract

A globe perforation is a well-known serious complication during peribulbar anesthesia. A second supplement injection may further increase the risk of this complication. Retrobulbar hemorrhage and brainstem injection are other serious complications have been reported following peribulbar injections. Although there is an increasing popularity for needle-free procedures of local anesthesia such as sub-tenon's injection and topical anesthesia, peribulbar anesthesia remains one of the favorite techniques for providing anesthesia in ophthalmic procedures. The risk for inadvertent globe perforation is increased if the patient has long axial length or posterior staphyloma. However, careful attention should be done to all patients and not only those with risk factors for globe perforation. Here we report a 69-year-old male patient referred to vitreoretinal surgeon with a vitreous hemorrhage due to a sever globe perforation during peribulbar anesthesia, in which early diagnosis and management helped in achieving a good final visual outcome. Also, in this case we discussed the safety of peribulbar anesthesia supplements, and how to avoid such complication. Using of balloon compression for adequate time to spread the local anesthesia around the globe and giving the injection with a shorter needle syringe may reduce the risk for inadvertent globe perforation following a supplemental peribulbar anesthesia injection.