A Case of Descemet's Membrane Detachment during Lidocaine Injection for Hordeolum Incision and Drainage

Bo-ram Kim; Si Yoon Park; Hyung Keun Lee; Kyoung Yul Seo; Eung Kweon Kim; Tae-im Kim

doi:10.3341/JKOS.2016.57.11.1790

Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010460

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Kim, Park, Lee, Seo, Kim, and Kim: A Case of Descemet's Membrane Detachment during Lidocaine Injection for Hordeolum Incision and Drainage

Case Report

J Korean Ophthalmol Soc 2016;57(11):1790-1794.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/JKOS.2016.57.11.1790

A Case of Descemet's Membrane Detachment during Lidocaine Injection for Hordeolum Incision and Drainage

Bo-ram Kim, MD¹, Si Yoon Park, MD¹, Hyung Keun Lee, MD, PhD^1,², Kyoung Yul Seo, MD, PhD^1,², Eung Kweon Kim, MD, PhD^1,², Tae-im Kim, MD, PhD^1,²

¹The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

²Corneal Dystrophy Research Institute, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Tae-im Kim, MD, PhD Department of Ophthalmology, Severanve Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: TIKIM@yuhs.ac

Received 4 August 2016 Revised 15 September 2016 Accepted 26 October 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of Descemet's membrane detachment and corneal edema caused by an iatrogenic corneal perforation created while performing a local anesthetic (lidocaine) injection into the eyelid for a hordeolum incision and a drainage procedure. The detachment resolved after 14% C₃ F₈ gas and air injections into the anterior chamber.

Case summary

An 8-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection into the upper eyelid in preparation for a hordeolum incision and drainage procedure. Corneal optical coherence tomography (OCT) showed Descemet's membrane detachment. Three days after the first visit, the corneal epithelium had entirely healed. However, Descemet's membrane detachment persisted even after three weeks of follow-up. A corneal OCT was repeated after three weeks and showed a partial Descemet's membrane rupture. A more aggressive treatment method was deemed necessary, and gas and air injections into the anterior chamber were performed. After 48 hours, aside from some Descemet's membrane rolling at the site of rupture, overall reattachment of Descemet's membrane was noted. After three months of follow-up, the patient showed a stable corneal state and normalized vision.

Conclusions

Descemet's membrane detachment and rupture resulting from an iatrogenic corneal perforation during an injection of lidocaine to the eyelid led to decreased visual acuity from corneal edema. As a more aggressive treatment method, 14 % C₃ F₈ gas and air injections into the anterior chamber were performed and resulted in near complete reattachment of Descemet's membrane's and normalization of the patient's visual acuity.

Keywords: Descemet's membrane rupture, Incision and drainage procedures for hordeolum, Local anesthesia

References

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Figure 1.

The images were taken on the injury day. On slit lamp examination, corneal edema (A) could be visualized with large corneal abrasion (B). Anterior segment optical coherence tomography across the plane marked on the anterior segment photo revealing Descemet's membrane detachment (C).

Figure 2.

The images were taken on the third week after injury. Arrows mark newly detected Descemet's membrane rupture at the primary puncture site by slit lamp examination (A, B). Anterior segment optical coherence tomography across the plane remarked on the anterior segment image showing Desmet's membrane rupture (C).

Figure 3.

The images were taken at 1 month after the procedure. Corneal edema was resolved and Descemet's membrane was attached in the area comprising the visual axis (A, B). Remaining strand-like Descemet's membrane folds can be seen by anterior segment optical coherence tomography at the injury site (C).

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