What is the typical duration of diplopia (double vision) after anesthesia?

Duration of Double Vision After Anesthesia

When diplopia occurs after retrobulbar or peribulbar anesthesia, it is typically transient and resolves within 6 months; if diplopia persists beyond 6 months without improvement, spontaneous resolution is unlikely and intervention should be considered. 1

Timeline for Resolution

Transient Diplopia (Most Common)

• Diplopia from anesthetic myotoxicity or direct muscle trauma typically resolves within 6 months in the majority of cases 1
• The 6-month threshold is the critical decision point: if diplopia has not resolved or shown improvement by this time, it is less likely to resolve spontaneously 1

Immediate/Short-Duration Cases

• Diplopia from dental local anesthesia (posterior superior alveolar blocks) typically resolves within 30 minutes to 24 hours, representing temporary cranial nerve VI involvement 2, 3, 4
• These cases involve different mechanisms (direct nerve anesthetic effect) and are self-limited 3, 4

Context-Specific Durations

After Ophthalmic Surgery with Retrobulbar Anesthesia

• Incidence of persistent diplopia: 0.18-0.23% with retrobulbar block anesthesia 1
• The diplopia may be either transient or persistent, with the 6-month mark being the key prognostic indicator 1
• Topical anesthesia carries much lower risk than regional blocks, though not zero 1

After Glaucoma Surgery

• Transient strabismus occurs in 4% after trabeculectomy and 4-25% after aqueous shunt surgery 1
• Most cases are transient, but persistent diplopia can occur in 2-77% depending on implant type and surgical technique 1

After Retinal Detachment Repair

• Ocular motility disturbances are transient and often resolve within 6 months after scleral buckle procedures 1
• Only 3.8% of patients required intervention for persistent strabismus in large series 1

Risk Factors for Persistent Diplopia

Higher risk patients include those with: 1

• Injection by non-ophthalmologist
• Left eye injection
• Absence of hyaluronidase in the anesthetic block
• Advanced age
• Pre-existing sensory strabismus (may be unmasked by surgery)

Clinical Approach

Observation Period

• Monitor for 6 months before considering intervention for post-anesthetic diplopia 1
• Document whether improvement is occurring during this period
• Perform detailed sensorimotor evaluation to characterize the deviation 1

When to Intervene

• If no resolution or improvement by 6 months, spontaneous recovery is unlikely and treatment options should be discussed 1
• Treatment options include prisms, orthoptic therapy, or strabismus surgery depending on the deviation pattern 5

Important Caveats

The mechanism matters for prognosis: 6, 5

• Direct muscle trauma or anesthetic myotoxicity (50% of cases) may show muscle overaction or underaction 6
• Sensory strabismus from unmasking pre-existing deviations (32% of cases) was often present but unnoticed preoperatively 6
• Preoperative strabismus evaluation is critical to identify patients at risk and provide appropriate counseling 6, 5

The evidence consistently supports the 6-month observation period as the standard for determining whether diplopia will be transient or persistent, with intervention warranted only after this timeframe if no improvement occurs.