Journal of the Korean Ophthalmological Society 2002;43(10):1982-1987.
Published online October 1, 2002.
Persistent Diplopia after Local Anesthesia.
Jeong Min Hwang, Jeong Hun Kim, Soo Kyung Han
1Department of Ophthalmology, Seoul Municipal Boramae Hospital, Korea. hjm@snu.ac.kr
2Department of Ophthalmology, Seoul National University College of Medicine, Korea.
3Department of Ophthalmology, Inje University College of Medicine, Korea.
국소마취 후 지속되는 복시
황정민 ( Jeong Min Hwang ) , 김정훈 ( Jeong Hun Kim ) , 한수경 ( Soo Kyung Han )
Abstract
PURPOSE
To determine causative factors of persistent diplopia after local anesthesia for ophthalmic surgery. METHODS: Prism and alternate cover test in the diagnostic positions of gaze and ductions/versions testing were performed in 26 patients with persistent diplopia six months after local anesthesia. Lancaster test, Bielshowsky head tilt test, double Maddox rod test, funduscopic examination for torsion, forced duction test, force generation test, tensilon test, thyroid function test, and/or orbit CT were done when necessary. RESULTS: Most of the patients (24 patients, 92%) did not have diplopia before local anesthesia. Of the thirteen patients with strabismus resulting from trauma to extraocular muscles, eleven patients showed vertical rectus overaction (10 superior recti, 1 inferior rectus) and two patients, mild vertical rectus underaction. Eight patients were presumed to have sensory deviation. In the remaining patients, one patient had childhood esotropia and another, old superior oblique palsy. Three patients showed a small vertical deviation without any specific cause. CONCLUSIONS: Fifty percent of diplopia was related with the surgical trauma to extraocular muscles, in which overactions (42%) were more common than underactions (8%). Thirty-five percent of the patients were presumed to have sensory deviation, which suggested the importance of preoperative examination for strabismus as well as the explanation about the risk of postoperative diplopia before surgery.
Key Words: Local anesthesia;Sensory deviation;Surgical trauma;Vertical rectus muscle overaction


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