Use of topical ice for local anesthesia for intravitreal injections.

Topical anesthetic allergy is a rare but recognized entity forwhich incidence is difficult to calculate owing to the difference between a perceivedand trueallergic response.Allergic episodesattributed to topical anesthetics are typically adverse reactions, such as a vasovagal event, rather than thedevelopmentofhypersensitivity.1However, several articles place the likely incidence of topical anesthetic allergy at less than 1% of the general population.1 The earliest description, to our knowledge, of a topical anesthetic allergyduringophthalmicuseoccurred in 1968whenanophthalmologist developedacontactdermatitis onhis thumband forefinger caused by proparacaine hydrochloride although he had no sensitivity to tetracaine.2 Documented cases of contact dermatitis caused by proparacaine and tetracaine have been reported in patientsaswell asophthalmologists.3Unfortunately, there is littlepublished about alternatives to topical anesthetics to achieve adequateanalgesiaduring in-officeexaminationoroffice-basedsurgical procedures. Here we describe the use of ice topical anesthesia for an intravitreal injection in a patient with a history of severe allergy to local anesthetics.