What's new in ophthalmic anaesthesia?

There have been many changes in ophthalmic anaesthesia in the past few years. This review charts recent trends in practice.

Topical anaesthesia is gaining widespread use for ophthalmic surgery, but readers need to be aware that definitions vary widely; some 'topical' techniques also include intracameral injections and adjunctive sedation. There is now evidence on the relative effectiveness of different types of local anaesthesia from large systematic reviews. Furthermore, the notion is emerging that the traditional distinction between peribulbar and retrobulbar blocks may not be as clear-cut as previously thought. A new area of investigation is the effect of local blocks on pulsatile ocular blood flow. However, the risk of ocular ischaemia has yet to be quantified. Local anaesthesia has also been tried for posterior segment surgery with apparently successful results. The management of patients taking anticoagulants and anti-platelet agents has been examined, and it appears that there are risks not only in continuing therapy but also in stopping it peri-operatively. The decision thus has to be taken on the balance of risks.

There have been significant further gains in our understanding of local anaesthetic eye blocks and the management of patients undergoing such procedures.