To describe a case of complete temporary visual loss after complicated cataract surgery with unpreserved intracameral lidocaine as an adjunctive anesthetic agent.

A 50-year-old man with posterior polar cataract underwent small-incision cataract surgery. Following capsulorhexis and hydrodelineation with 1cc unpreserved lidocaine 1%, a portion of fluid reached behind the crystalline lens while posterior capsule had been ruptured. Anterior vitrectomy and lensectomy were performed and a 3-piece hydrophobic acrylic IOL, was implanted in the ciliary sulcus and the eye was patched.

On the first post-operative morning, the patient complained of not seeing anything. His vision was recorded as no light perception. The relative afferent pupillary defect (RAPD) was found to be 4+.The fundus was examined under full pupillary dilation. Retina and optic nerve head appeared normal. In the afternoon, the patient’s visual acuity (VA) was improved to 3-meter count-finger. In the next early morning, the patient’s VA returned to normal 20/20 without RAPD.

when a posterior capsular rupture is suspected or likely, it is wise not to use intracameral lidocaine as an adjunctive anesthetic to avoid its potential retinal toxicity.