Essentials of Ocular Anaesthesia: Techniques, Indications, and Complications

Ocular anesthesia provides pain relief and immobilization of the eye while minimizing local and systemic complications in ocular surgery. This review discusses various types of anesthesia techniques including topical, regional (local), and general anesthesia, highlighting their indications, techniques, and potential complications in ocular surgery. Local anesthesia, encompassing topical drops, retrobulbar, peribulbar, and sub-Tenon’s blocks, is the preferred choice for most intraocular surgeries due to its safety profile and efficacy. It is indicated where general anesthesia is unnecessary and patient cooperation is achievable, like cataract extraction, glaucoma surgeries, corneal transplantation, and retinal procedures. However, local anesthesia may be contraindicated in cases of known allergies, nystagmus, high myopia, staphyloma, enophthalmos, or when prolonged surgery duration is anticipated. Patient preparation, preoperative education, assessment of bleeding risks, and ocular anatomy is crucial to optimize outcomes and avoid complications like wrong-site surgery. Various anesthetic agents and adjuncts, like lignocaine, bupivacaine, hyaluronidase, epinephrine, and sodium bicarbonate, are utilized to achieve optimal anesthesia. The complications associated with ocular anesthesia range from transient visual impairment to serious events like brainstem anesthesia and retrobulbar hemorrhage. Understanding these risks and proper management strategies is essential for minimizing adverse outcomes. This review underscores the importance of tailored anesthesia choice based on individual patient characteristics and surgical requirements to ensure optimal surgical outcomes.