[Local anesthesia with accidental perforation of the eye--an acute emergency?]

A report on 3 instances of accidental injection of lidocaine into the eye. Among the immediate reactions were (1) development of corneal edema due to an abrupt rise in intraocular pressure, (2) dilatation and paralysis of the pupil, (3) decrease of visual acuity to light perception. In 2 of the patients pupillary reaction and retinal function recovered completely; the third developed a permanent field defect. The effects of intraocular injection of lidocaine, epinephrine and hyaluronidase were subsequently studied in an animal model. The corneal and pupillary reactions of the animals correlated with those of the 3 patients. The b-wave of the electroretinogram, representing the function of the internal retinal layers, was temporarily extinguished but recovered completely after 4 hours. Subsequent light and electron microscopic study of the animal retinas did not reveal any drug induced damage. Following intraocular injection of lidocaine, epinephrine, or hyaluronidase permanent damage to the retina or irreversible reduction in visual acuity was observed neither in the first 2 patients nor in the animals.