title: Strabismus complications from local anesthetics.
abstract: Strabismus developing after retrobulbar or peribulbar anesthesia for both anterior and posterior segment eye surgery may be due to myotoxicity to an extraocular muscle from the local anesthetic agent. Initial paresis often causes diplopia immediately after surgery, but later progressive segmental fibrosis occurs, and/or hypertrophy of the muscle, producing diplopia in the opposite direction from the direction of the initial diplopia. The inferior rectus muscle is most commonly affected. Usually a large recession on an adjustable suture of the involved muscle(s) yields good alignment. Using topical anesthesia or sub-Tenon's anesthesia can avoid this complication.
authors.affiliation: The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-9028, USA. dguyton@jhmi.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Guyton
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects* / Q000627:therapeutic use; D000869:Anterior Eye Segment / Q000601:surgery*; D004172:Diplopia / Q000209:etiology; D004338:Drug Combinations; D004357:Drug Synergism; D005355:Fibrosis; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D006984:Hypertrophy; D009801:Oculomotor Muscles / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D013508:Ophthalmologic Surgical Procedures; D009886:Ophthalmoplegia / Q000139:chemically induced / Q000150:complications; D013285:Strabismus / Q000139:chemically induced* / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D006821:Hyaluronoglucosaminidase