To the Editor.
—Peribulbar anesthesia, in which local anesthetic is injected outside the muscle cone, has been cited by proponents as having the advantages of greater ease of performance and a lower rate of globe perforation. Rates of globe perforation were low for both techniques in a series of 2000 cases of peribulbar anesthesia in which no globe perforations were reported1 and a series of 4000 cases of retrobulbar anesthesia in which three globe perforations were reported.2 To our knowledge, there are no published case reports of globe perforation after peribulbar injection.
Report of a Case.
—An 82-year-old man underwent peribulbar injection of the left eye in preparation for cataract extraction. With a 22-gauge standard sharp-tipped needle, the anesthesiologist injected 3 mL of lidocaine hydrochloride-bupivacaine hydrochloride mixture into the inferotemporal orbit outside the muscle cone and the same volume into the superonasal orbit. No difficulty was experienced during
Kimble JA, Morris RE, Witherspoon CD, Feist RM. Globe Perforation From Peribulbar Injection. Arch Ophthalmol. 1987;105(6):749. doi:10.1001/archopht.1987.01060060035017