Literature review on the use of bupivacaine for strabismus management
Reviewed by Fiona Rowe

The purpose of this study was to examine the overall efficacy of bupivacaine (BPX) when used in isolation for the treatment of strabismus. This was a literature review from 1980 to 2021. The search identified 196 papers of which eight met the inclusion criteria. BPX concentrations and volumes ranged from 0.75 to 3% and 0.50 to 5mL. Doses were typically dependent on the size of deviation with doses <1.0mL unlikely to yield clinically significant results. A dose response curve of 3.1PD to 1.0mL was suggested by one included study. There was a variable overall change in primary gaze deviation. Deviations <11PD were shown to have smaller angle changes. An initial increase was noted for muscle volume followed by a gradual decrease. Patient experience of discomfort with the procedure was noted but there was general overall patient satisfaction. BPX was found to be not suited for treatment of cranial nerve palsies. The authors conclude BPX is a good treatment alternative for small angle deviations of 10-20PD.

The efficacy of bupivacaine for the treatment of strabismus.
Farrelly-Waters M, Smith J, Parmar K.
STRABISMUS
2022;30(1):42-7.