Severe visual loss caused by ocular perforation during chalazion removal

PURPOSE: To report two cases of ocular perforation during chalazion removal procedures leading to severe vision loss. DESIGN: Observational case series. METHODS: Two patients presented with unilateral decreased vision after chalazion removal procedures. Complete ophthalmologic examinations were performed. RESULTS: Examination revealed a cherry red spot and perforation site in the first patient. In the second patient, there was an intraocular gas bubble and ischemic retina. CONCLUSIONS: Local anesthetic injections for procedures such as chalazia removal can result in ocular perforation. We postulate that the intraocular injections led to extremely high pressures, compromising the blood supply to the retina and optic nerve. Anesthetic injections for all procedures, even chalazia removal, should be done with great caution. It is imperative to avoid injection if ocular perforation is suspected, as the high pressure may cause the majority of the visual morbidity.