Hyaluronidase allergy mimicking orbital cellulitis

Area of Science:

• Ophthalmology
• Allergy and Immunology
• Anesthesiology

Background:

• Hyaluronidase is commonly used with local anesthetics in ophthalmic surgery to enhance drug penetration.
• Adverse reactions to hyaluronidase, though rare, can present with significant clinical signs.
• Distinguishing hyaluronidase hypersensitivity from orbital cellulitis is crucial for appropriate patient management.

Purpose of the Study:

• To report a series of patients with clinical features mimicking orbital cellulitis after peribulbar anesthesia.
• To highlight hyaluronidase hypersensitivity as a potential diagnosis in such cases.
• To emphasize the importance of recognizing and differentiating hyaluronidase allergy.

Main Methods:

• Retrospective review of five patients diagnosed with hyaluronidase allergy between 2011 and 2015.
• Evaluation of presenting features including periocular edema, proptosis, and restricted ocular movements.
• Confirmation through ophthalmic evaluation, investigations, and positive dermal allergy tests for hyaluronidase.

Main Results:

• All five patients tested positive for hyaluronidase allergy.
• Symptoms, appearing from immediately to 6 days post-surgery, mimicked orbital cellulitis.
• Treatment with antihistamines, steroids, and decompression (when needed) resulted in symptom resolution within 3-5 days for most patients.

Conclusions:

• Hyaluronidase hypersensitivity is a critical differential diagnosis for orbital cellulitis post-ophthalmic surgery.
• Early identification and management of hyaluronidase allergy lead to excellent prognoses.
• Ophthalmic surgeons and anesthetists must be aware of this condition to avoid misdiagnosis and ensure timely intervention.