Sir,

Regarding the case report by Redmill, Sandy and Rose,1 it should not be intuitively surprising that purulent orbital cellulitis resulted from a sub-Tenon’s local anaesthetic given in the presence of active corneal ulceration. The authors do not state whether corneal scrapings were taken nor what the culture results of the scrapings were. The fact that they administered topical ofloxacin however suggests at least a clinical suspicion of active infection.

My personal experience suggests that sub-Tenon’s or other invasive local anaesthetic are not necessary for the procedure of corneal gluing. This can be accomplished quite satisfactorily using topical anaesthesia in every case that I have dealt with. (A highly uncooperative patient would generally be unsuitable for gluing since they also presumably would be uncooperative following the procedure with a risk of eye rubbing.)

Perhaps therefore the main lessons to be drawn from this case report are firstly, that if invasive local anaesthesia is not necessary, it should not be used, and secondly, that it should be used with extreme caution in the presence of suspected or proven active infection of the external eye.