title: Inferior oblique overaction/contracture following retrobulbar anesthesia for cataract extraction with a positive Bielschowsky Head Tilt test to the contralateral shoulder. A report of one case.
abstract: OBJECTIVE
  This is a report of a patient with diplopia, hypertropia, extorsion and a positive Bielschowsky Head Tilt Test following retrobulbar anesthesia, due to an inferior oblique muscle overaction-contracture.
  
  
  METHODS
  Oculomotor and sensorimotor examinations and ocular motility recordings and Bielschowsky Head Tilt Test demonstrated overaction characteristics overpowering the contracture characteristics of the involved inferior oblique muscle.
  
  
  RESULTS
  Weakening of the overacting inferior oblique eliminated the vertical and torsional deviations and the forced head tilt difference upon tilting the head to either shoulder. It also normalized ocular motility and resulted in a symptom-free patient.
  
  
  CONCLUSIONS
  Oblique muscle dysfunction with vertical and torsional deviations and a positive Bielschowsky Head Tilt Test can result from retrobulbar anesthesia.
authors.affiliation: Department of Ophthalmology, American University of Beirut Medical Center, Lebanon.
authors.forename: Edward
authors.initials: E
authors.lastname: Khawam
authors.forename: Mays
authors.initials: M
authors.lastname: El-Dairi
authors.forename: Christine
authors.initials: C
authors.lastname: Al-Haddad
authors.forename: Mohammad
authors.initials: M
authors.lastname: Younis
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects*; D019162:Anesthetics, Combined / 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; D019416:Head Movements; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000009:adverse effects; D019654:Lens Implantation, Intraocular; D008012:Lidocaine / Q000009:adverse effects; D008875:Middle Aged; D009121:Muscle Denervation; D009801:Oculomotor Muscles / Q000187:drug effects* / Q000294:innervation; D013285:Strabismus / Q000139:chemically induced*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D006821:Hyaluronoglucosaminidase; D002045:Bupivacaine