Sir,

Regarding the case report by Redmill et al,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 or 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 with which I have dealt. (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.