Oral abstract presentation times
11th Rapid Fire
Abstract ID: 26-328
A Case Series of Orbital Compartment Syndrome Secondary to sub-Tenon’s Hyaluronidase Injection
Author: Aneeta Kumar Base Hospital / Institution: Moorfields Eye Hospital NHS Foundation Trust
Presentation Type: Rapid Fire Presentation Session: Trauma / War / MiscellaneousDate: 11th SeptemberTime: 09.12
Purpose
Orbital compartment syndrome (OCS) is a sight-threatening emergency, most associated with orbital surgery and trauma. We present a case series of four patients who developed OCS due to severe hypersensitivity to hyaluronidase, an adjunct used to enhance local anaesthesia distribution.
Methods
A retrospective review of patients diagnosed with perioperative OCS between August 2024 and July 2025. Clinical data were collected from medical records, including surgical and anaesthetic details, as well as the management and outcomes of OCS.
Results
4 patients presented with perioperative OCS: 1 shortly after sub-Tenon’s anaesthesia, 1 intraoperatively during Descemet Membrane Endothelial Keratoplasty, 1 on post-operative day 1 following phacoemulsification and 1 on post-operative day 1 after combined phacoemulsification and panretinal photocoagulation. No intraoperative complications were reported.
All patients received sub-Tenon’s anaesthesia with a mix of bupivacaine (n=3), lidocaine (n=4), and hyaluronidase (n=4). All patients had complex ocular history, including glaucoma (n=3), cataract surgery (n=4), glaucoma tube insertion (n=2) and vitrectomy (n=2). Mean baseline visual acuity (VA) was 6/96.
At presentation, mean VA dropped to hand movements, while mean IOP rose to 57.7mmHg. All patients had urgent lateral canthotomy and cantholysis, while 3 had systemic steroids and 2 had antibiotics. Mean VA improved to 6/190, but 1 patient deteriorated from 6/12 to no perception of light.
Computed tomography in all cases revealed significant soft tissue swelling and inflammatory stranding, without retrobulbar haemorrhages or large collections. Allergy testing confirmed severe hypersensitivity to hyaluronidase. No dose-related associations were noted. However, all patients had multiple prior exposures, raising the possibility of sensitisation.
Conclusion
This is the largest case series of hyaluronidase-associated OCS. Repeated exposure over multiple ocular surgeries may predispose to sensitisation. Early recognition and urgent canthotomy are critical to optimising visual outcomes.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Rubaiyat | Haque | Guy’s and St Thomas’ NHS Foundation Trust |
| Niaz | Islam | Moorfields Eye Hospital NHS Foundation Trust |
| Allan | Nghiem | Moorfields Eye Hospital NHS Foundation Trust |