Abstract: Besides anesthetic effect, bupivacaine, an aminoamide anesthetic, can also cause the injected muscles experiencing a process of  degeneration, necrosis and regeneration, which may increase intrinsic elastic stiffness, enlarge the size of the muscle, and finally strengthen the muscle force. It has been reported that bupivacaine can improve the eye alignment in horizontal, nonparalytic strabismus by increasing the stiffness and contractility of the injected muscle.  Meanwhile, there are some researches focusing on the pathological changes of the muscle to study the underneath mechanism. This review introduces the most updated information of clinical research and related mechanism of bupivacaine to discuss the possible future research of bupivacaine in strabismus.