To the Editor:—

I read with interest the recent report by Guise on sub-Tenon anesthesia for cataract surgery. 1The author’s technique was to incise the fused conjunctiva and anterior tenon capsule and insert a catheter in the posterior sub-Tenon space for the injection of 4 ml of local anesthetic. However, subconjunctival hemorrhages were noted in 7% of the cases, and 4.1% of the patients required an additional facial nerve block for persistent orbicularis tone. Moreover, 0.8% required a retrobulbar top-up block.

Guise’s technique for cataract surgery seems extremely complicated, considering that several surgeons at our facility almost exclusively use a topical technique, usually with tetracaine eyedrops 2,3or a topical technique supplemented with intracameral lidocaine. 4 

I would appreciate the author’s thoughts regarding the reasons he advocates the sub-Tenon approach, rather than simple topical anesthesia.


Guise PA: Sub-Tenon anesthesia: A prospective study of 6,000 blocks. A nesthesiology 2003; 98: 964–8
Fichman RA: Use of topical anesthesia alone in cataract surgery. J Cataract Refract Surg 1996; 22: 612–4
Naor J, Slomovic AR: Anesthesia modalities for cataract surgery. Curr Opin Ophthalmol 2000; 11: 7–11
Carino NS, Slomovic AR, Chung F, Marcovich AL: Topical tetracaine versus topical tetracaine plus intracameral lidocaine for cataract surgery. J Cataract Refract Surg 1998; 24: 1602–8