The present paper presents three cases of transient internal ophthalmoplegia during blepharoplasty. All cases were characterized by a dilated pupil that was unreactive to light or an accommodative stimulus. There were no cases of visual loss or permanent pupillary abnormalities. We attribute the temporary pupillary mydriasis and accommodative insufficiency to anesthesia of the short ciliary nerves or ciliary ganglion from local anesthetic diffusing into the orbit at the time of injection. To the best of our knowledge this is a complication of eyelid surgery that has not been previously described.