We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Local Anesthesia in Oculoplastic Surgery Precautions and Pitfalls

M. Reza Vagefi, MD; Chun Cheng Lin, MD; John D. McCann, MD, PhD; Richard L. Anderson, MD
Arch Facial Plast Surg. 2008;10(4):246-249. doi:10.1001/archfaci.10.4.246.
Text Size: A A A
Published online


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.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Cross-sectional anatomy of the upper and lower eyelids.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

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.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles