Second cluster of strabismus cases after periocular anesthesia without hyaluronidase

We describe a second cluster of cases of iatrogenic strabismus that occurre d in clinical practices following cataract surgeries that occurred in 2000 when hyaluronidase was once again unavailable for use in periocular anesthe tic regimens. Twelve cases of transient or permanent strabismus were referr ed by 4 anterior segment surgeons who had no previous cases of postcataract strabismus when performing periocular injections with hyaluronidase. The c harts of the patients were reviewed retrospectively. Recurrence of an incre ase in postoperative strabismus when hyaluronidase became unavailable for a second time supports the concept that this enzyme may be more important th an previously suspected in preventing damage to the extraocular muscles aft er periocular anesthetic injections. (C) 2001 ASCRS and ESCRS.