title: Effects of local anesthesia with bupivacaine plus epinephrine on blepharoptosis and levator palpebrae muscle function.
abstract: OBJECTIVE
  To evaluate the effect of local anesthesia with bupivacaine plus epinephrine on the extent of blepharoptosis and levator palpebrae muscle function.
  
  
  METHODS
  : In this prospective interventional case series, patients with blepharoptosis who were candidates for aponeurotic surgery were included. After initial preparations in the operating room, a total of 1 ml of a mixture of bupivacaine 0.5% plus epinephrine 1:100,000 were injected into the upper eyelid. The margin reflex distance 1 (MRD1) and the extent of levator muscle function were measured before and 2, 5, 10, and 15 minutes after injection.
  
  
  RESULTS
  A total of 36 eyes including 21 men (58.3%) and 15 women (41.7%) with an average age of 41.81 ± 23.09 (17-83 years) were studied. There were 21 eyes with myogenic and 15 eyes with aponeurotic blepharoptosis. The mean MRD1 was 1.18 ± 1.06 mm before injection and -0.02 ± 0.85, 0.52 ± 0.98, 0.98 ± 1.05, and 1.02 ± 1.06 mm at 2, 5, 10, and 15 minutes after injections, respectively. The changes in the MRD1 measurements were statistically significant at all time points. The MRD1 values decreased during the first 2 minutes after injection in 88.8% of eyes, but returned to initial value after 15 minutes in 84.3%. The change in the levator muscle function measurements was statistically significant at 2 and 5 minutes after injections; however, the differences were clinically negligible.
  
  
  CONCLUSIONS
  : The local anesthesia of the eyelid with 1 ml bupivacaine plus epinephrine causes a temporary increase of blepharoptosis within the first few minutes with minimal effect on levator muscle function measurements.
authors: Department of Ophthalmology and Eye Research Center, Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran. synaghai@gmail.com
authors: Gholam Hoseyn
authors: GH
authors: Aghai
authors: Maryam
authors: M
authors: Vazirnia
authors: Rama
authors: R
authors: Poormatin
authors: Khalil Ghasemi
authors: KG
authors: Falavarjani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001763:Blepharoptosis / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D001767:Blinking / Q000502:physiology; D002045:Bupivacaine / Q000008:administration & dosage*; D004338:Drug Combinations; D004837:Epinephrine / Q000008:administration & dosage*; D005143:Eyelids / Q000187:drug effects; D005260:Female; D006801:Humans; D056965:Injections, Intraocular; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D013566:Sympathomimetics / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D013566:Sympathomimetics; D002045:Bupivacaine; D004837:Epinephrine