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Pretreatment with systemic corticosteroid can mask early symptoms of hypersensitivity reaction to hyaluronidase following peribulbar block
  1. Ashok Gupta1,
  2. Bruttendu Moharana2,
  3. Reeti Saini1 and
  4. Arjun Gupta1
  1. 1Department of Ophthalmology, Drishti Eye Hospital, Panchkula, Haryana, India
  2. 2Department of Ophthalmology, All India Institute of Medical Science - Bhopal, Bhopal, Madhya Pradesh, India
  1. Correspondence to Dr Bruttendu Moharana; drmoharana{at}


Hyaluronidase is a hydrolytic enzyme that helps in breaking down hyaluronic acid, a component of the extracellular tissue matrix, thereby facilitating the dispersion of local anaesthetic drugs through tissue planes. It is a key component in peribulbar anaesthesia for ocular surgeries. Allergic response to hyaluronidase is relatively rare but a potentially vision-threatening complication. A preoperative intradermal hypersensitivity test is useful to detect such cases and avoid potential complications. Here we report a case of hypersensitivity reaction to hyaluronidase after peribulbar anaesthesia for cataract surgery where an intradermal hypersensitivity test was falsely negative, and presentation was delayed due to the use of preoperative systemic corticosteroids. However, correct, and timely diagnosis and treatment saved the eye from permanent vision loss.

  • anaesthesia
  • eye
  • ophthalmology

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  • Contributors AG: manuscript editing and final approval; BM: manuscript design, preparation, editing and literature search; RS: literature search, manuscript editing; AG: manuscript editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.