Sever inadvertent globe perforation during supplemental peribulbar anesthesia injection

Nayef F. Alswaina


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.


Globe perforation, Peribulbar anesthesia complication, Supplement peribulbar injection

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McLure HA, Rubin AP. Local anaesthesia for ophthalmic surgery. Curr Anaesth Crit Care. 1999;10:40-7.

Lee A, Wildsmith JA. Local anaesthetic techiques. In: Aitkenhead AR, Smith G, editors. Textbook of Anaesthesia. 3rd ed. London: Churchill Livingstone; 1996:445-69.

Gillow JT, Aggarwal RK, Kirkby GR. A survey of ocular perforation during ophthalmic local anaesthesia in the United Kingdom. Eye (Lond). 1996;10:537-8.

Davis DB, Mandel MR. Efficacy and complication rate of 16 224 consecutive peribulbar blocks. J Cataract Refract Surg. 1994;20:327-37.

Edge R, Navon S. Scleral perforation during retrobulbar and peribulbar anaesthesia: risk factors and outcome in 50 000 consecutive injections. J Cataract Refract Surg. 1999;25:1237-44.

Duker JS, Belmont JB, Benson WE, Brooks HL, Brown GC, Federman JL, et al. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia: patient characteristics, surgical management, and visual outcome. Ophthalmol. 1991 Apr 1;98(4):519-26.

Grizzard WS, Kirk NM, Pavan PR, Antworth MV, Hammer ME, Roseman RL. Perforating ocular injuries caused by anesthesia personnel. Ophthalmol. 1991 Jul 1;98(7):1011-6.

Ball JL, Woon WH, Smith S. Globe perforation by the second peribulbar injection. Eye. 2002;16:663-5.

Riad W. Peribulbar blockade with a short needle for phacoemulsification surgery. Acta Anaesthesiol Scand. 2009;53(2):247-50.

Spire M, Fleury J, Kodjikian L, Grange JD. Retinal detachment caused by ocular perforation during periocular anesthesia: three case reports. J Fr Ophtalmol. 2007 Jun;30(6):e16.