Lagophthalmos after v2 maxillary nerve block

We report a previously undescribed complication associated with percutaneous maxillary nerve blockade. After the procedure, the patient reported an inability to close her ipsilateral eye (lagophthalmos). The patient had received 5 mL of 0.5% lidocaine for skin anesthesia. After needle placement was confirmed fluoroscopically, a combination of 80 mg methylprednisolone (2 mL) and 0.25% bupivacaine (3 mL) was administered. Symptoms resolved within 40 minutes. The likely cause was local anesthetic effect on the zygomatic branches of the facial nerve. When subcutaneous local anesthetic is given for maxillary block, smaller volumes should be considered. Doctors and patients should be aware of this complication, which may require treatment with artificial tears or patching of the eye to prevent corneal injury.