title: Are ocular injection anesthetic blocks obsolete? Indications and guidelines.
abstract: OBJECTIVE
  In this era of topical anesthesia for ocular surgery, anesthetic ocular blocks are still important when profound anesthesia and akinesia are required. Although injection ocular blocks, retrobulbar and peribulbar anesthesia, have been supplanted for most ocular surgery in many centers by sub-Tenon's irrigation block because of its superior safety profile, still worldwide, injection blocks remain popular.
  
  
  RESULTS
  We present here the results of a survey of the literature published over the last 5 years to assess current international preferences for ocular anesthesia injection blocks. We discuss the reasons why sub-Tenon's anesthesia is not more universally popular and advocate for its greater acceptance because of safety. Specific narrow indications for performing injection ocular blocks are presented. Also, guidelines for performing retrobulbar anesthesia which reduce the risk of serious ocular complications are provided as well as our rationale for preferring retrobulbar to peribulbar anesthesia.
  
  
  CONCLUSIONS
  Sub-Tenon's block should be performed in the operating theatre in preference to retrobulbar or peribulbar anesthesia except for limited indications. When injection ocular block is deemed necessary, we feel that retrobulbar anesthesia with the technique described may be safer than peribulbar anesthesia.
authors.affiliation: Ophthalmology Service, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Mavrakanas
authors.forename: Christina
authors.initials: C
authors.lastname: Stathopoulos
authors.forename: James S
authors.initials: JS
authors.lastname: Schutz
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D006801:Humans; D056965:Injections, Intraocular; D009407:Nerve Block / Q000379:methods*; D009915:Orbit; D017410:Practice Guidelines as Topic
chemical_list: D000779:Anesthetics, Local