Allergic Reaction to Hyaluronidase After Retrobulbar Anaesthesia: a Case Series and Review

Overview

Journal Int Ophthalmol

Specialty Ophthalmology

Date 2008 Sep 12

PMID 18784901

Citations 11

Authors

L Delaere

T Zeyen

B Foets

J Van Calster

I Stalmans

Affiliations

Soon will be listed here.

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.

Citing Articles

Superior Outcomes with Ultrasound-Guided Hyaluronidase for Impending Filler-Induced Facial Skin Necrosis: A Systematic Review and Pilot Meta-Analysis.

Boey J, Boey J, Chen Z, Cao T, Tan A, Ng Z Aesthetic Plast Surg. 2025; .

PMID: 39881073 DOI: 10.1007/s00266-025-04707-0.

Conventional High-Dose vs Low-Dose Hyaluronidase for Skin Necrosis after Hyaluronic Acid Fillers: A Systematic Review and Pilot Meta-Analysis.

Boey J, Boey J, Cao T, Ng Z Aesthetic Plast Surg. 2024; 48(19):3971-3978.

PMID: 39214904 DOI: 10.1007/s00266-024-04334-1.

Hyaluronidase for Dermal Filler Complications: Review of Applications and Dosage Recommendations.

Kroumpouzos G, Treacy P JMIR Dermatol. 2024; 7:e50403.

PMID: 38231537 PMC: 10836581. DOI: 10.2196/50403.

Allergic Complications of Hyaluronidase Injection: Risk Factors, Treatment Strategies, and Recommendations for Management.

Guliyeva G, Huayllani M, Kraft C, Lehrman C, Kraft M Aesthetic Plast Surg. 2023; 48(3):413-439.

PMID: 37145319 DOI: 10.1007/s00266-023-03348-5.

Efficacy of submucosal injection of hyaluronidase after mandibular third molar surgery: a randomized controlled trial.

Lee S, Kim H, Nam W J Korean Assoc Oral Maxillofac Surg. 2022; 48(6):363-370.

PMID: 36579908 PMC: 9807377. DOI: 10.5125/jkaoms.2022.48.6.363.

References

Eberhart A, Weiler C, Erie J . Angioedema related to the use of hyaluronidase in cataract surgery. Am J Ophthalmol. 2004; 138(1):142-3. DOI: 10.1016/j.ajo.2004.02.035. View

Musa F, Srinivasan S, King C, Kamal A . Raised intraocular pressure and orbital inflammation: a rare IgE-mediated allergic reaction to sub-Tenon's hyaluronidase. J Cataract Refract Surg. 2006; 32(1):177-8. DOI: 10.1016/j.jcrs.2005.11.024. View

Kirby B, Butt A, Morrison A, Beck M . Type I allergic reaction to hyaluronidase during ophthalmic surgery. Contact Dermatitis. 2001; 44(1):52. DOI: 10.1034/j.1600-0536.2001.440107-19.x. View

Nicholson G, Hall G . Allergic reaction to hyaluronidase after a peribulbar injection. Anaesthesia. 2003; 58(8):814-5. DOI: 10.1046/j.1365-2044.2003.03295_18.x. View

Guise P, Laurent S . Sub-Tenon's block: the effect of hyaluronidase on speed of onset and block quality. Anaesth Intensive Care. 1999; 27(2):179-81. DOI: 10.1177/0310057X9902700209. View

Sarvela J, Nikki P . Hyaluronidase improves regional ophthalmic anaesthesia with etidocaine. Can J Anaesth. 1992; 39(9):920-4. DOI: 10.1007/BF03008340. View

Prosser D, Rodney G, Mian T, Jones H, Khan M . Re-evaluation of hyaluronidase in peribulbar anaesthesia. Br J Ophthalmol. 1996; 80(9):827-30. PMC: 505621. DOI: 10.1136/bjo.80.9.827. View

Crawford M, Kerr W . The effect of hyaluronidase on peribulbar block. Anaesthesia. 1994; 49(10):907-8. DOI: 10.1111/j.1365-2044.1994.tb04273.x. View

Dempsey G, Barrett P, Kirby I . Hyaluronidase and peribulbar block. Br J Anaesth. 1997; 78(6):671-4. DOI: 10.1093/bja/78.6.671. View

10.

Szepfalusi Z, Nentwich I, Dobner M, Pillwein K, Urbanek R . IgE-mediated allergic reaction to hyaluronidase in paediatric oncological patients. Eur J Pediatr. 1997; 156(3):199-203. DOI: 10.1007/s004310050582. View

11.

Leibovitch I, Tamblyn D, Casson R, Selva D . Allergic reaction to hyaluronidase: a rare cause of orbital inflammation after cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2005; 244(8):944-9. DOI: 10.1007/s00417-005-0190-5. View

12.

Kempeneers A, Dralands L, Ceuppens J . Hyaluronidase induced orbital pseudotumor as complication of retrobulbar anesthesia. Bull Soc Belge Ophtalmol. 1992; 243:159-66. View

13.

Minning Jr C . Hyaluronidase allergy simulating expulsive choroidal hemorrhage. Arch Ophthalmol. 1994; 112(5):585-6. DOI: 10.1001/archopht.1994.01090170029012. View

14.

Rowley S, Hale J, Finlay R . Sub-Tenon's local anaesthesia: the effect of hyaluronidase. Br J Ophthalmol. 2000; 84(4):435-6. PMC: 1723446. DOI: 10.1136/bjo.84.4.435. View

15.

Krohn J, Seland J, HOVDING G, Bertelsen T, AASVED H, Haugen O . Retrobulbar anesthesia with and without hyaluronidase in extracapsular cataract surgery. A prospective, randomized, double-blind study. Acta Ophthalmol (Copenh). 1993; 71(6):791-5. DOI: 10.1111/j.1755-3768.1993.tb08602.x. View

16.

Escolano F, Pares N, Gonzalez I, Castillo J, Valero A, Bartolome B . Allergic reaction to hyaluronidase in cataract surgery. Eur J Anaesthesiol. 2005; 22(9):729-30. DOI: 10.1017/s0265021505251190. View

17.

Ebo D, Goossens S, Opsomer F, Bridts C, Stevens W . Flow-assisted diagnosis of anaphylaxis to hyaluronidase. Allergy. 2005; 60(10):1333-4. DOI: 10.1111/j.1398-9995.2005.00891.x. View

18.

Youssef Z, Pennefather P, Watts M . Orbital cellulitis vs allergic reaction to hyaluronidase as the cause of periorbital oedema. Eye (Lond). 2004; 19(6):691-2. DOI: 10.1038/sj.eye.6701553. View

19.

Quhill F, Bowling B, Packard R . Hyaluronidase allergy after peribulbar anesthesia with orbital inflammation. J Cataract Refract Surg. 2004; 30(4):916-7. DOI: 10.1016/j.jcrs.2003.08.024. View

20.

Nicoll J, Treuren B, Acharya P, Ahlen K, James M . Retrobulbar anesthesia: the role of hyaluronidase. Anesth Analg. 1986; 65(12):1324-8. View