This interesting and well-documented article,1 published in July 1995, deserves a comment relating to the technique recommended for retrobulbar block. The authors use a 35-mm, 27-gauge, sharp needle to enter the orbit to a depth of 25 mm. This long, thin, sharp needle is then angled up medially and advanced to the hub of the needle.
If the sclera is thin, a thin, sharp needle may penetrate the globe without the surgeon's feeling it. Thinness of sclera occurs not only in myopic eyes, since equatorial staphylomas in emmetropic eyes are not rare. Moreover, a long, thin needle is flexible and efforts to change its direction inside the orbit may bend the needle in unwanted directions, which increases the danger of perforating the globe.
For the 50 years of my surgical practice, I have used the Arruga technique. It consists of using a long-bevel, 22-gauge needle with a specially blunted
Schepens CL. A Comparison of Peribulbar and Retrobulbar Anesthesia for Vitreoretinal Surgical Procedures. Arch Ophthalmol. 1996;114(4):502. doi:10.1001/archopht.1996.01100130498040