Oculoplastic surgeons are fortunate that most of the operative procedures can be performed with local anesthesia. With the exception of orbital or endoscopic brow procedures, the ability to operate on or around the eyelids for functional or aesthetic reasons is usually limited only by the patient's age, significant medical problems, and/or ability to tolerate a more conscious state during surgery. For many of these procedures, the patient's anesthetic needs are low, and surgery can be performed in an office setting using local anesthesia in conjunction with an oral anxiolytic and analgesic.
Cross-sectional anatomy of the upper and lower eyelids.
Considerations for periocular local anesthesia injections. A, The needle should be bent 30° superiorly at its base to allow it to exit anteriorly through the skin during injection should the patient move. B, Injection of the upper eyelid is performed with the needle passed parallel to the skin in a subcutaneous plane where it can easily be visualized. The noninjecting hand spreads the tissues with traction and steadies the patient's head. C, Lower eyelid anesthesia is begun with a subconjunctival injection with the needle directed parallel to the globe after prior placement of topical anesthetic in the lower fornix. The noninjecting hand retracts the lower eyelid down for direct visualization.
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