Retrobulbar Injection: Technique and Tips

In this clinical video, Dr. Julian Perry and colleagues demonstrate their technique for delivering retrobulbar anesthesia. After ensuring the patient’s eye is in primary gaze, palpate the inferior orbital rim while gently pushing up on the globe. Insert the needle just above the rim at the lateral third of the eyelid. The needle is advanced, bevel up, parallel to the orbital floor. After about 1 cm when the needle has passed the equator, redirect to about 30° superonasally, and advance the needle an additional 2.5 cm. After aspirating to ensure no blood returns, slowly inject between 3 to 4 ml of anesthesia. Mild pressure should be applied after removing the needle to prevent hemorrhage and increase diffusion of the agent. He offers several pointers, and suggests using a round-tipped retrobulbar needle whenever possible. Clinicians should not inject if there is any resistance or globe rotation and should be aware of possible risks, including globe perforation, optic nerve injury and retrobulbar hemorrhage.

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