Elevation deficit after cataract surgery under peribulbar anesthesia: A case report

A 59-year-old male presented with binocular double vision for the past year, characterized by vertical separation of the images and single vision achieved with a rightward head turn. His intraocular pressures were 19 mmHg and 10 mmHg in the right and left eyes, respectively. Bilateral cataract surgery was performed 1 year prior, with the right eye operated on first, followed by the left eye 1 week later under peribulbar anesthesia. The patient reported a history of repeated injections during the right-eye surgery. There was no history of recent trauma, headache, fever, or systemic disorders. Clinical examination and imaging revealed right superior rectus palsy secondary to peribulbar block, leading to the diagnosis of likely superior rectus myotoxicity. Surgical intervention with right-eye inferior-rectus recession resulted in improved symptoms postoperatively. This case underscores the potential complication of superior-rectus myotoxicity following peribulbar block and highlights the effectiveness of surgical intervention in resolving diplopia.