Anesthetic injection aligned vision in a strabismus patient

An injection of bupivacaine reduced esotropia by 10 D in a strabismus patient, according to a case report published in the February issue of the British Journal of Ophthalmology.

Alan B. Scott, MD, and colleagues at the Smith-Kettlewell Eye Research Institute in San Francisco injected 4.5 mL of a 0.75% solution of bupivacaine into the right lateral rectus muscle of a diplopic patient with 14 D of esotropia. The surgeons sought to harness the anesthetic-induced hypertrophy, which has proven safe in animal models, the authors said.

The patient's right lateral rectus muscle remained paralyzed for 7 days before regaining its abducting ability. Over the next 33 days, the patient's alignment improved to 4 D of esophoria. Diplopia was eliminated, and alignment was maintained at 54 days' follow-up, they said.

An MRI showed a 58% focal increase in the posterior right lateral rectus muscle and reduced change in the anterior portions, they noted.