Bupivacaine as a treatment option for age-related distance esotropia
Reviewed by Lauren Hepworth

The purpose of this study was to identify if bupivacaine is an effective treatment for age-related distance esotropia (ARDE) as an alternative or adjuvant to surgery. This was a retrospective study with review of all bupivacaine treatment cases in a single centre from 2022–24. There were 14 injections to 13 patients during this time. 4 did not meet inclusion criteria and 2 had no follow-up. Therefore, 7 cases were included (8 injections). The study included a second group of 11 surgical candidates (lateral rectus resection). In the surgery group, mean preoperative angle was 14PD, mean resection of 4.8mm (no complications), postoperative angle of 3.9PD, average follow-up of 44 days, 64% surgical success, 1 using prisms postoperatively, 1 requiring reoperation and 2 progressing to bupivacaine injection. In the injection group, mean preoperative angle was 7.3PD reducing to 4.1PD postoperatively with a follow-up of 143 days. Surgical success was 63% with 1 requiring surgery and 1 requiring a second injection. There were significant differences in angles for groups. The authors conclude that bupivacaine can be used to successfully treat ARDE but acknowledge surgical bias in the selection of cases, as large angles tended to require surgery whilst smaller angles were injected. Recurrence for some cases in each group suggested both treatment options may not give long-lasting effects. The results demonstrate early evidence for bupivacaine but this treatment requires further comparative research with large patient numbers.

Bupivacaine injections for the treatment of age-related distance esotropia.
Wood MK, Marsh IB.
STRABISMUS
2026;34(1):10–3.