In cooperative patients, topical anesthetic eyedrops alone (eg, tetracaine 0.5%, proparacaine 0.5%, lidocaine 2%) are effective for most steps in an EOM surgical procedure. Topical anesthesia is not effective for control of the pain produced by pulling on or against a restricted muscle or for cases in which exposure is difficult.
Both peribulbar and retrobulbar anesthesia make most EOM procedures pain-free and should be considered in adults for whom general anesthesia may pose an undue hazard. The administration of a short-acting hypnotic by an anesthesiologist just before retrobulbar injection greatly improves patient comfort. Because injected anesthetics may influence alignment during the first few hours after surgery, suture adjustment is best delayed for at least half a day.
General anesthesia is necessary for children and is often used for adults as well, particularly those requiring bilateral surgery. Neuromuscular blocking agents such as succinylcholine, which are administered to facilitate intubation for general anesthesia, can temporarily affect the results of a traction test. Nondepolarizing agents, which do not have this effect, can be used instead.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.