J Korean Ophthalmol Soc.  2019 Oct;60(10):994-998. 10.3341/jkos.2019.60.10.994.

Corneal Stromal Edema during Lidocaine Injection for Blepharoplasty

• Jun SY
• Choi YJ
• Cho YJ

• KMID: 2460519
• DOI: http://doi.org/10.3341/jkos.2019.60.10.994

Abstract

PURPOSE
To report a case of corneal edema caused by an iatrogenic lidocaine injection into the corneal stroma created while performing a local anesthetic (lidocaine) injection into the eyelid for a blepharoplasty procedure.
CASE SUMMARY
A 15-year-old female visited our clinic after the onset of severe pain and decreased visual acuity while receiving a local anesthetic injection in the upper blepharon for a blepharoplasty procedure. At the first clinical visit, visual acuity was hand motion and an accurate anterior chamber examination was difficult because of corneal edema. The Seidel test was negative. On corneal optical coherence tomography, the corneal thickness was 1,580 µm without any sign of Descemet's membrane detachment. We prescribed 5% NaCl four times a day and prednisolone acetate eight times a day. On the next day after injury, the corneal edema was significantly improved (central corneal thickness: 660 µm), and Descemet's membrane detachment was still not observed. One week after injury, the naïve visual acuity was 20/20, the central corneal thickness was 560 µm, and the endothelial cell count was 3,260 cells/cm². Three weeks after injury, the corneal edema was fully resolved and only slight temporal corneal haziness remained. After 2 months, the cornea was clear without any subjective discomfort.
CONCLUSIONS
Corneal edema without Descemet's membrane detachment can be resolved spontaneously without aggressive treatment such as gas or air injection. However, endothelial cell count and corneal opacity need to be monitored on follow up exam. This clinical experience suggests that severe corneal edema in anterior stromal layer could be spontaneously resolved without severe complication.

Keyword

Blepharoplasty; Corneal edema; Local anesthesia

MeSH Terms

Adolescent
Anesthesia, Local
Anterior Chamber
Blepharoplasty*
Cornea
Corneal Edema
Corneal Opacity
Corneal Stroma
Descemet Membrane
Edema*
Endothelial Cells
Eyelids
Female
Follow-Up Studies
Hand
Humans
Lidocaine*
Prednisolone
Tomography, Optical Coherence
Visual Acuity
Lidocaine
Prednisolone

Figure

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  Figure 1 The images were taken on the injury day. On slit examination, corneal edema could be visualized (A). Anterior segment optical coherence tomography revealing significant corneal edema (thickness: 1,580 µm), no evidence of Descemet's membrane detachment was observed (B).

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  Figure 2 The images were taken on the next day after injury. On slit lamp examination, corneal edema was significantly improved and small corneal abrasion was visualized on temporal side of it (A). Anterior segment optical coherence tomography showing significantly improved corneal edema (thickness: 660 µm) and still no evidence of Descemet's membrane detachment (B).

• 

  Figure 3 The images were taken at 1 week (A), 3 weeks (B) and 2 months (C) after the injury. Corneal edema was resolved (A) and slight corneal haziness was observed at injury site (B, C).

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