I read with interest the case report by Dahlmann et al1 describing a case of postoperative orbital cellulitis with a possible underlying infective cause from routine subtenon anaesthesia.

Similar case reports have been published earlier2 and more recently,3 and thus the comment by Dahlmann et al on being the first report of such case is erroneous. In our reported case,2 the signs of infection were also present very early on the second day after surgery, but the degree of orbital cellulitis and endophthalmitis progressed rapidly with poor visual outcome despite prompt systemic and topical treatment.

It was also unclear in the report by Dahlmann et al whether the patient had indeed received a preparation of the lids and conjunctiva with povidone-iodine before the subtenon injection. This procedure is now widely adopted by anaesthetists in the anaesthetic room together with appropriate draping, and has been shown to reduce the incidence of postoperative infection.4 Additional topical povidone-iodine applied into the conjunctival sac preoperatively would be recommended but only with an appropriately diluted concentration to avoid ocular toxicity.