Bupivacaine
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Acquired Brown syndrome: case report A 36-year-old woman developed acquired Brown syndrome following administration of bupivacaine to induce anaesthesia. The woman, who had mild unilateral proptosis of the right eye, presented to the oculoplastics clinic. She underwent right inferior orbital fat decompression. Local anaesthetic therapy was administered using a 25-gauge needle with 0.5% bupivacaine and other concomitant medications, injected inferiorly and superonasally. On post-operative day-1, she developed vertical diplopia. Her visual acuity was found to be 20/20 in both eyes. On inspection, it was observed that she had been using right head tilt position to relieve her diplopia. On primary gaze, she had left hypertropia. The hypertropia was found to be increased, with limited elevation of the right eye on attempted adduction. Additionally, she had a mild degree of exotropia at primary position. Forced duction test of the right eye showed resistance on elevation in adduction. She neither underwent strabismus surgery, nor had diplopia prior to the surgery. An MRI of the orbit without contrast showed alteration in signal, thickening and irregularity involving the right superior oblique tendon and trochlea region. Based on these findings and clinical presentation, she was diagnosed with acquired Brown syndrome, which occurred due to bupivacaine. The woman was treated with single dose of triamcinolone near the intra-trochlear region. Also, forced duction tests were repeated several times. Additionally, unspecified NSAIDs and Fresnel prisms were prescribed. In addition, she was recommended to perform elevation exercises at home, which included frequent adduction and elevation of the right eye thrice daily. On serial follow-up after 2 weeks, clinical improvement was noted. Following 12 weeks of the local anaesthesia administration, diplopia on primary gaze resolved completely. However, residual left-hypertropia of 18 prism diopters persisted on left gaze. She did not require any further surgical intervention. Alsarhani WK, et al. Brown syndrome from local anesthesia for inferior orbital fat decompression. American Journal of Case Reports 21: 1-4, 2020. Available from: URL: 803496929 http://doi.org/10.12659/AJCR.924678
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Reactions 22 Aug 2020 No. 1818
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