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Br J Ophthalmol 2007;91:146-148 doi:10.1136/bjo.2006.110619
  • Clinical science
    • Scientific reports

Bupivacaine injection of eye muscles to treat strabismus

  1. Alan B Scott,
  2. Danielle E Alexander,
  3. Joel M Miller
  1. Smith-Kettlewell Eye Research Institute, San Francisco, California, USA
  1. Correspondence to: A B Scott Smith-Kettlewell Eye Research Institute, 2318 Fillmore Street, San Francisco, CA 94115, USA; abs{at}ski.org
  • Accepted 9 November 2006
  • Published Online First 29 November 2006

Abstract

Background: Bupivacaine injected into animal muscles induces a cycle of myotoxicity, degeneration, regeneration and hypertrophy of muscle fibres, without adverse effects on other tissues. This induced hypertrophy can be harnessed to treat strabismus.

Methods: Bupivacaine, 4.5 ml of a 0.75% solution, was injected into the right lateral rectus (RLR) muscle of a patient who had diplopia and who showed 14-prism-dioptres oesotropia.

Results: RLR paresis persisted for 7 days. Then, the RLR regained its abducting ability, and progressive improvement of alignment to 4-prism-dioptres oesophoria occurred over the next 33 days, with the elimination of diplopia. Alignment remained the same at 54 days after injection. Magnetic resonance imaging showed a focal increase in the size of the injected RLR of 58% in the posterior area, with reduced change in anterior portions of the RLR.

Conclusion: Injection of bupivacaine to induce hypertrophy of the injected muscle and thus alter eye alignment was effective in our patient. This approach can be a useful addition to the treatment of strabismus.

Footnotes

  • Funding: This work was supported by the Pacific Vision Foundation and by USPHS grants EY08313 and EY015314.

  • Published Online First 29 November 2006

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