Postoperative diplopia and ptosis. A clinical hypothesis based on the myotoxicity of local anesthetics

Arch Ophthalmol. 1985 Sep;103(9):1337-9. doi: 10.1001/archopht.1985.01050090089038.


Postoperative diplopia and ptosis can be temporary or permanent complications in patients who have undergone ophthalmic surgery while under local anesthesia. We encountered six patients with such complications and hypothesize that some cases of postoperative diplopia and ptosis could be attributed to myotoxic effects of local anesthetics. These effects may cause the degeneration and subsequent regeneration of muscle fibers of the levator or extraocular muscles and result in temporary or permanent muscle weakness.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Anesthetics, Local / adverse effects*
  • Blepharoptosis / chemically induced*
  • Bupivacaine / adverse effects
  • Cataract Extraction*
  • Diplopia / chemically induced*
  • Epinephrine / adverse effects
  • Female
  • Humans
  • Lenses, Intraocular
  • Lidocaine / adverse effects
  • Male
  • Mepivacaine / adverse effects
  • Middle Aged
  • Oculomotor Muscles / drug effects*
  • Postoperative Complications


  • Anesthetics, Local
  • Lidocaine
  • Mepivacaine
  • Bupivacaine
  • Epinephrine