title: Inferior oblique muscle injury from local anesthesia for cataract surgery.
abstract: BACKGROUND
  Vertical rectus muscle injury is commonly cited as a cause of strabismus after cataract surgery. Injury to the inferior oblique muscle or nerve as a complication of cataract surgery has not been described previously.
  
  
  METHODS
  Four patients without pre-existing strabismus who had diplopia after cataract surgery were studied. Analysis included prism and cover testing, Lancaster red-green testing, and fundus torsion assessment.
  
  
  RESULTS
  Three patients had a delayed-onset hypertropia with fundus extorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle overaction secondary to presumed contracture. The fourth patient had an immediate-onset hypotropia with fundus intorsion in the eye that underwent surgery, which is consistent with inferior oblique muscle paresis. Damage to a vertical rectus muscle or "unmasking" of a pre-existing superior oblique muscle paresis could not explain the history and findings in this group of four patients.
  
  
  CONCLUSIONS
  The inferior oblique muscle contracture observed in three patients may have been caused by local anesthetic myotoxicity, whereas the paresis observed in one patient may have been due to mechanical trauma or anesthetic toxicity directly to the nerve innervating the muscle. Inferior oblique muscle or nerve injury should be considered as another possible cause of postoperative strabismus, especially when significant fundus torsion accompanies a vertical deviation.
authors.affiliation: Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore.
authors.forename: D G
authors.initials: DG
authors.lastname: Hunter
authors.forename: G C
authors.initials: GC
authors.lastname: Lam
authors.forename: D L
authors.initials: DL
authors.lastname: Guyton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D002045:Bupivacaine / Q000009:adverse effects; D002387:Cataract Extraction; D003286:Contracture / Q000139:chemically induced*; D004172:Diplopia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D016602:Needlestick Injuries / Q000150:complications; D009801:Oculomotor Muscles; D013285:Strabismus / Q000139:chemically induced*; D014787:Vision Tests
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine