title: Cluster of diplopia cases after periocular anesthesia without hyaluronidase.
abstract: OBJECTIVE
  To describe a cluster of cases of iatrogenic diplopia after cataract surgery that occurred in 1998, when hyaluronidase was unavailable for use in periocular anesthetic regimens.
  
  
  METHODS
  The clinical practices of the authors.
  
  
  METHODS
  This study comprised a retrospective chart review.
  
  
  RESULTS
  Twenty-five cases of transient or permanent diplopia were reported. Of these, 13 eyes had retrobulbar and 10 had peribulbar injections; in 2 cases the injection technique was unknown. The inferior rectus was affected in 19 eyes; of these, 1 had a temporary palsy and 18 had permanent restriction. Temporary paresis developed in the lateral rectus in 5 cases and the superior rectus in 2. Eleven cases were submitted by 4 anterior segment surgeons, who collectively had a zero incidence of iatrogenic postoperative diplopia in the preceding 4 to 11 years of practice (approximately 6900 cases).
  
  
  CONCLUSIONS
  Hyaluronidase may be more important than previously suspected in preventing anesthetic-related damage to the extraocular muscles. The inferior rectus muscle is particularly vulnerable, presumably because of the injection technique.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Texas Tech University Health Sciences Center, Lubbock 79430, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Brown
authors.forename: S E
authors.initials: SE
authors.lastname: Brooks
authors.forename: M L
authors.initials: ML
authors.lastname: Mazow
authors.forename: C W
authors.initials: CW
authors.lastname: Avilla
authors.forename: D E
authors.initials: DE
authors.lastname: Braverman
authors.forename: S T
authors.initials: ST
authors.lastname: Greenhaw
authors.forename: M E
authors.initials: ME
authors.lastname: Green
authors.forename: D L
authors.initials: DL
authors.lastname: McCartney
authors.forename: G C
authors.initials: GC
authors.lastname: Tabin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000009:adverse effects*; D019162:Anesthetics, Combined; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002387:Cataract Extraction; D016000:Cluster Analysis; D004172:Diplopia / Q000209:etiology* / Q000517:prevention & control; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase; D007049:Iatrogenic Disease; D007267:Injections / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects; D009915:Orbit; D012189:Retrospective Studies
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine; D004837:Epinephrine