title: Transient impaired vision, external ophthalmoplegia, and internal ophthalmoplegia after blepharoplasty under local anesthesia.
abstract: OBJECTIVE
  To report a case of transient bilateral vision impairment with external ophthalmoplegia and internal ophthalmoplegia after blepharoplasty under local anesthesia.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  A 70-year-old man underwent bilateral upper blepharoplasty under local anesthesia. During orbital fat removal additional anesthetic was injected into both medial fat pads for pain control.
  
  
  RESULTS
  Immediate postoperative examination revealed bilateral decreased visual acuity and internal ophthalmoplegia in the right eye. An exotropia was present with marked limitation of right eye adduction. These findings resolved completely 3 hours postoperatively.
  
  
  CONCLUSIONS
  Local anesthesia during blepharoplasty can enervate the optic nerve, ciliary ganglion, and extraocular muscle nerves. Local anesthesia should be injected judiciously during orbital fat removal to avoid this reversible but alarming event.
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle, Washington 98195-6485, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Oliva
authors.forename: A J
authors.initials: AJ
authors.lastname: Ahmadi
authors.forename: Raghu
authors.initials: R
authors.lastname: Mudumbai
authors.forename: James L
authors.initials: JL
authors.lastname: Hargiss
authors.forename: Bryan S
authors.initials: BS
authors.lastname: Sires
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019882:Blepharoplasty / Q000009:adverse effects*; D001766:Blindness / Q000209:etiology* / Q000503:physiopathology; D005143:Eyelids / Q000601:surgery; D006801:Humans; D008297:Male; D009886:Ophthalmoplegia / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity
chemical_list: D000779:Anesthetics, Local