Acute Hypertensive Surge Causing Massive Subconjunctival Hemorrhage During Routine Cataract Surgery: A Video Case Report

To report a rare intraoperative complication in an otherwise healthy patient with stable, treated systemic hypertension who developed a sudden hypertensive surge during cataract surgery, resulting in massive subconjunctival hemorrhage and interruption of the procedure.

inward routine cataract surgery

A patient with no ocular comorbidities and controlled hypertension underwent standard phacoemulsification under topical anesthesia. Shortly after wound construction, an abrupt rise in systemic blood pressure occurred, leading to rapid, diffuse subconjunctival hemorrhage. The hemorrhage expanded across the bulbar conjunctiva, obscuring visibility and preventing the surgeon from safely proceeding. Surgery was suspended, and the anesthesiologist initiated immediate antihypertensive management.

Stabilization of systemic parameters required approximately 20 minutes. Once blood pressure normalized and the ocular surface findings were controlled, the patient was scheduled for surgery on a later date. No postoperative systemic or ocular complications occurred.

This case highlights an uncommon but potentially alarming hypertensive event during routine cataract surgery.

Even in patients with apparently stable hypertension, intraoperative stress can trigger acute systemic surges capable of compromising ocular surgical safety. Vigilant monitoring and rapid multidisciplinary coordination are essential to ensure appropriate risk management and guide the decision to continue or suspend surgery.