Anesthetic myotoxicity as a cause of restrictive strabismus after scleral buckling surgery

Purpose: To explore the possibility that anesthetic myotoxicity may play a role in restrictive strabismus following scleral buckling procedures. Methods: The authors performed a retrospective study of patients who presented with strabismus following scleral buckling procedures. Details were sought regarding the scleral buckling procedure, including type and route of anesthesia. The types of strabismus were compiled, as were relevant findings at strabismus surgery. The contributing vitreoretinal surgeons were surveyed regarding the usual type and route of anesthesia used for their scleral buckling procedures. Results: Over 90% of scleral buckling procedures resulting in significant strabismus were performed under local anesthesia. Of the 17 patients on whom strabismus surgery was performed, 14 had positive forced ductions. A hypodeviation of the buckled eye was the most common presentation. Conclusion: Based on the types, patterns, and amounts of strabismus encountered after scleral buckling procedures, and the similarity of these findings to cases of strabismus following retrobulbar anesthesia for cataract procedures, the authors propose that local anesthetic myotoxicity is often the primary cause of strabismus occurring after scleral buckling procedures for retinal detachment.