Ocular myotoxic effects of local anesthetics

Of 650 patients who underwent various surgical procedures on the anterior segment in which 2% lidocaine hydrochloride plus 1:100,000 epinephrine was used as a local anesthetic, 5 experienced postoperative complications attributed to the anesthetic: ptosis (in 2 cases), horizontal rectus muscle palsy (in 2) and lagophthalmos (in 1). The cause of the complications may have been inadvertent direct infiltration of the anesthetic into the levator palpebrae superioris, the horizontal rectus muscles and the orbicularis oculi respectively. All the patients recovered spontaneously in 8 to 12 weeks. The clinical course was compatible with myotoxic effects of local anesthetics.