Topical anesthesia for phacoemulsification and painless subconjunctival antibiotic injection

Endophthalmitis is a serious postoperative complication of phacoemulsification surgery. Administration of a subconjunctival antibiotic is a common method of prophylaxis in the United Kingdom and other countries. Injection of subconjunctival cefuroxime can be very painful, especially after phacoemulsification under topical anesthesia. Our experience is that this could be the only painful step in the entire operation. We evaluated a technique in which buffered lignocaine is injected into the subconjunctival space before the antibiotic injection. The technique was used in 46 eyes (46 patients) that had phacoemulsification under topical anesthesia. Eighty-seven percent of patients found the injection painless, 6.5% reported that the pain was very negligible, and 6.5% reported a moderate degree of pain.