Vertical and cyclotorsional deviations following peribulbar anesthesia.

Abstract

Motility disorders may occur consecutive to peribulbar anesthesia. The underlying pathology is still debated. The aim of the study was to contribute to the discussion by a meticulous orthoptic examination of a series of patients. In a series of 16 patients with diplopia after peribulbar anesthesia, measurements of the angle of squint in the nine directions of gaze, Bielschowsky's headtilt test and motility analysis were performed. The findings were discussed with regard to the possible types of muscular lesions. Hypotropia and deorsoadduction accompanied by relatively small cyclotropia were found in all cases. Bielschowsky's head-tilt test mostly revealed neutral findings. The findings were discussed under the hypothesis of a fibrotic muscular change in the superior oblique and inferior rectus muscle. This hypothesis turned out to be concordant with the orthoptic measurements, implying that treatment of the disorder should consist in low-dosage recession of the fibrotic muscles, which in our experience was rewarding.