title: Diplopia and ptosis following injection of local anesthesia without hyaluronidase.
abstract: In a university ophthalmology department, a cluster of postoperative diplopia and ptosis cases occurred in the initial 3 months after hyaluronidase (Wydase) became unavailable for use with injection anesthesia. These cases suggest that hyaluronidase, when used with injection anesthesia, may protect extraocular muscles and nerves from the toxic effects of local anesthetic agents. The spreading action of hyaluronidase facilitates uniform diffusion of anesthetic agents. This prevents elevated extracellular tissue pressure, a cause of ischemic damage to extraocular muscles or nerves. Hyaluronidase may also prevent focal accumulations and concentrations of local anesthetic agents, which at high enough levels may cause myotoxic or neurotoxic damage, fibrosis, and contracture of extraocular muscles or nerves.
authors.affiliation: Department of Ophthalmology, University of Kansas Medical Center, Kansas City, Kansas, USA.
authors.forename: F S
authors.initials: FS
authors.lastname: Jehan
authors.forename: J C
authors.initials: JC
authors.lastname: Hagan
authors.forename: T J
authors.initials: TJ
authors.lastname: Whittaker
authors.forename: M
authors.initials: M
authors.lastname: Subramanian
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D019162:Anesthetics, Combined / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001763:Blepharoptosis / Q000139:chemically induced*; D002045:Bupivacaine / Q000009:adverse effects; D004172:Diplopia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D006821:Hyaluronoglucosaminidase; D007267:Injections / Q000009:adverse effects; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D009801:Oculomotor Muscles / Q000187:drug effects; D018918:Phacoemulsification
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine