Superior oblique overaction from local anesthesia for cataract surgery

Traumatic superior oblique dysfunction from cataract surgery appears to be rare, with only 3 reported cases of postoperative Brown syndrome 1,2 and 1 reported case of postoperative superior oblique weakness. 3 We are not aware of any prior reports of superior oblique overaction occurring after cataract surgery. We describe a patient with acquired superior oblique overaction as a cause of vertical strabismus after cataract surgery. Ocular torsion analysis was essential in localizing the malfunction to the superior oblique muscle. The most likely etiology is myotoxicity from inadvertent intramuscular injection of local anesthetic before cataract surgery.