Inadvertent intravitreal lidocaine injection following subcutaneous palpebral anesthesia: retinal toxicity of lidocaine?

Introduction: We report an atypical case of scleral perforation due to an inadvertent intravitreal lidocaine injection following palpebral anesthesia. We discuss the management of this rare complication and focus on the transient lidocaine toxicity on human retina. Observation: A 29-year-old man presented with unilateral decreased vision during a lower right palpebral anesthetic injection for a chalazion removal procedure. The patient's vision was light perception. Examination revealed intraocular pressure at 55 mmHg, a wound of the posterior crystalloid, an intraocular gas bubble, and a central retinal artery spasm. On ERG, the b wave was decreased. The central retinal artery spasm resolved with prompt reduction of hypertony. Twenty-four hours later, the vision was 6/10 and the ERG showed an increased b wave activity. No clinical retinal toxicity of lidocaine was observed. Only a subcapsular cataract was observed, which had caused the loss of vision. Conclusion: This case confirms that lid ocaine is well tolerated by the retina and reminds us that superficial palpebral anesthetic injection should be done with great caution.