• Postoperative diplopia and ptosis can be temporary or permanent complications in patients who have undergone ophthalmic surgery while under local anesthesia. We encountered six patients with such complications and hypothesize that some cases of postoperative diplopia and ptosis could be attributed to myotoxic effects of local anesthetics. These effects may cause the degeneration and subsequent regeneration of muscle fibers of the levator or extraocular muscles and result in temporary or permanent muscle weakness.
Rainin EA, Carlson BM. Postoperative Diplopia and PtosisA Clinical Hypothesis Based on the Myotoxicity of Local Anesthetics. Arch Ophthalmol. 1985;103(9):1337–1339. doi:10.1001/archopht.1985.01050090089038