retrobulbar block

This is a more intense way of numbing and paralyzing the eye before difficult eye surgery. Cataract surgery is normally performed under topical anesthesia – simple numbing drops placed on the eye while the patient remains awake. However, if we anticipate that a cataract surgery may take longer than usual (a dense cataract) or may require more manipulation (such as pupil stretching) than a “block” can be considered.  With this technique, our patient is temporarily sedated by an anesthesiologist and put completely asleep for about 1-2 minutes.  While asleep, the doctor (anesthesiologist or ophthalmologist) injects the retrobulbar numbing agent behind the eyeball itself. This completely numbs the eye and paralyzes the muscles that control eye movement and blinking.  This makes the surgery much easier as there is no chance for pain or any unexpected eye movements during the procedure.  The downside to a retrobulbar block is that it is more invasive and may require clearance from a primary doctor first. If on blood thinners, these will need to be stopped ahead of time to decrease the chance of bleeding behind the eye from the injection.  Finally, the temporary eyelid paralysis means the eye has a harder time closing immediately after surgery and may need to be patched shut overnight to keep the eye from drying out. This is inconvenient and may require a “safety stitch” during the surgery that extends operating time.  In our patient population here in Daytona Beach, about one in twenty people require one of these blocks.  In other parts of the world where everyone has a terrible, dense cataract (India for example) the majority of surgery is done with a retrobulbar block.