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Large exotropia after retrobulbar anesthesia.

Chung-Hwan Kim, Ungsoo Samuel Kim1

  • 1Department of Ophthalmology, Konyang University College of Medicine, Daejeon; Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea, KOrea.

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Summary

Retrobulbar anesthesia may cause lateral rectus muscle injury, leading to significant exotropia after cataract surgery. This complication can result in double vision and require surgical intervention.

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Area of Science:

  • Ophthalmology
  • Anesthesiology

Background:

  • Cataract surgery with intraocular lens implantation is a common procedure.
  • Retrobulbar anesthesia is frequently used for ophthalmic surgeries.

Observation:

  • A 67-year-old woman developed horizontal diplopia post-bilateral cataract surgery.
  • She received retrobulbar anesthesia (lidocaine/bupivacaine) via inferotemporal injection.
  • Initial evaluation revealed 12 PD exotropia with limited adduction, worsening to 60 PD over one year.

Findings:

  • Surgical intervention included lateral rectus recession.
  • Biopsy of the lateral rectus muscles showed dense fibrous tissue, devoid of viable muscle cells.
  • This suggests potential injury to the lateral rectus muscle from retrobulbar anesthesia.

Implications:

  • Retrobulbar anesthesia may be an iatrogenic cause of lateral rectus muscle damage.
  • This muscle injury can lead to significant, progressive exotropia.
  • Ophthalmologists and anesthesiologists should be aware of this potential complication.