We would like to thank Dr Schepens for his interesting comments concerning the use of larger-gauge blunt-tipped needles in performing regional anesthesia for ocular surgery. The technique of peribulbar anesthesia described in our article used a shorter needle than that which is used for retrobulbar anesthesia. We thought that it was less likely to flex into the path of the globe when inserted into the orbital tissues. However, the actual localization of the needle shaft and tip cannot be determined with confidence by clinical means alone as demonstrated by ultrasonic localization.1 The findings of Birch et al confirm the impressions of Dr Schepens that the surgeon may be lulled into a false sense of complacency when performing any intraorbital injections by using only anatomic landmarks. The benefit of using a blunt-tipped needle, however, is less clear without additional study and was not specifically addressed in our report.
Dhaliwal R, Demediuk OM. A Comparison of Peribulbar and Retrobulbar Anesthesia for Vitreoretinal Surgical Procedures-Reply. Arch Ophthalmol. 1996;114(4):502. doi:10.1001/archopht.1996.01100130498041