Comparison of bupivacaine injection vs. mini-tenotomy for small angle deviations
Reviewed by Fiona Rowe

Bupivacaine hydrochloride is an aminoacyltype local anaesthetic. Injection into extraocular muscles elicits a myotoxic response destroying striated muscle fibres but sparing satellite cells, nerves and vessels. Preserved satellite cells proliferate to form new muscle fibres, causing muscle hypertrophy and greater contractile strength. This simulates surgical resection effects. In this study, the authors compared bupivacaine injection versus mini-tenotomy of muscles in treating small angle horizontal strabismus in children. This was a prospective comparative study of 40 children. Group 1 - as below (20 children, mean age 6.70 ±2.13 years) had 3ml of 0.75% bupivacaine to the medial rectus for exotropia or lateral rectus for esotropia (bilateral injections). Group 2 - as below (20 children, mean age 5.85 ±2.16 years) had bilateral central mini-tenotomy of the lateral rectus for exotropia and medial rectus for esotropia. Both groups had similar numbers of eso / exotropia cases, all deviations preop were <15PD, and no significant differences in change in alignment across both groups. Change in alignment was at maximum effect by three months postop for group 1. Overall improvement for both groups was 65%; 10% were <5PD in group 1 vs. 20% <5PD in group 2. Both options were deemed safe and effective as surgical treatment options for small angle deviations.

Comparison between bupivacaine injection and mini-tenotomy in the management of horizontal small angle strabismus in children.
Al-Saeed WN, Elhilali HM, Kamel AM, et al.
STRABISMUS
2023;31(3):172–81.