Vertical and cyclotorsional deviations following peribulbar anesthesia

Background: Motility disorders may occur consecutive to peribulbar anesthes ia. The underlying pathology is still debated. The aim of the study was to contribute to the discussion by a meticulous orthoptic examination of a ser ies of patients. Methods: In a series of 16 patients with diplopia after pe ribulbar anesthesia, measurements of the angle of squint in the nine direct ions of gaze, Bielschowsky's head-tilt test and motility analysis were perf ormed. The findings were discussed with regard to the possible types of mus cular lesions. Results: Hypotropia and deorsoadduction accompanied by relat ively small cyclotropia were found in all cases. Bielschowsky's head-tilt t est mostly revealed neutral findings. Conclusion: The findings were discuss ed under the hypothesis of a fibrotic muscular change in the superior obliq ue and inferior rectus muscle. This hypothesis turned out to be concordant with the orthoptic measurements, implying that treatment of the disorder sh ould consist in low-dosage recession of the fibrotic muscles, which in our experience was rewarding.