title: Bupivacaine injection to lateral rectus in abducens nerve palsy.
abstract: A 49-year-old female presented with bilateral abducens nerve palsies. She had 75 prism diopter esotropia. The extraocular movement of the lateral rectus was -1 limitation for the right eye and -4 limitations for the left. After performing orbital magnetic resonance imaging (MRI), 2 mL of bupivacain (5 mg/mL) was injected into the left lateral rectus (LR). One month after injection, a further orbital MRI was performed. Subsequently, recession of both medial rectus (6 mm) and resection of the left LR (9 mm) were performed. After one month, bupivacaine had no hypertrophic effects. There was little change in angle of deviation. The orbital MRI scan showed a 1.91% increase in volume compared to the muscle prior to the injection. Histological findings showed no muscle fibers of the left LR muscle, only the fiber nucleus and the collagen that replaced the fibers. We report on the changes in stiffness and muscle volume and on the histology of the muscle one month after injecting bupivacaine into the paralyzed left LR muscle combined with standard surgical treatment.
authors.affiliation: Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea. Kseeye@hanmail.net
authors.forename: Sungeun
authors.initials: S
authors.lastname: Kyung
authors.forename: Jihoon
authors.initials: J
authors.lastname: Jeon
mesh_terms: D000010:Abducens Nerve / Q000473:pathology*; D020434:Abducens Nerve Diseases / Q000188:drug therapy* / Q000473:pathology; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: Abducens nerve diseases; Bupivacaine; Magnetic resonance imaging
references.citation: J AAPOS. 2009 Apr;13(2):119-22
references.pmid: 19393509
references.citation: J Anat. 1970 Nov;107(Pt 3):547-56
references.pmid: 5492943
references.citation: Rev Oculomot Res. 1988;2:33-79
references.pmid: 3153651
references.citation: Br J Ophthalmol. 1974 Mar;58(3):193-216
references.pmid: 4134570
references.citation: J Neurol Sci. 1996 Dec;144(1-2):147-55
references.pmid: 8994117
references.citation: Invest Ophthalmol Vis Sci. 2001 Jan;42(1):17-22
references.pmid: 11133843
references.citation: Ophthalmology. 1996 Jun;103(6):918-21
references.pmid: 8643247
references.citation: Cell Tissue Res. 1980;209(1):131-5
references.pmid: 7428022
references.citation: Trans Am Ophthalmol Soc. 2009 Dec;107:104-9
references.pmid: 20126486