Periocular local anesthesia: medial orbital as an alternative to superior nasal injection

We developed a new technique, the medial orbital pericone local anesthetic block, that surgeons can use a secondary block when inferotemporal retrobulbar or peribulbar/periocular injection of local anesthetics results in incomplete anesthesia. Unlike secondary local injections placed in the superonasal quadrant of the orbit, our technique injects the anesthetic into the fat compartment of the nasal side of the globe, a site that is relatively avascular and lacks vital anatomic structures. In more than 15,000 patients, this method proved an effective, safe means of secondary block and promoted orbicularis oculi muscle akinesia.