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July 1953


Author Affiliations

From the Department of Ophthalmology, College of Medical Evangelists.

AMA Arch Ophthalmol. 1953;50(1):78. doi:10.1001/archopht.1953.00920030081012

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ONE OF the most painful procedures during cataract surgery is the injection of a local anesthetic in the region of the superior rectus muscle preparatory to the placement of a control suture. Moreover, if this injection should fail to take effect, the passing of the needle through the muscle may easily become the most painful part of the entire operation.

The normal pressure of the upper lid against the eyeball prevents a sufficient concentration of topical anesthetic from remaining in the upper cul-de-sac even if a sufficient amount of the solution is placed there by drawing away the lid. According to Duke-Elder, the upper cul-de-sac is 13 mm. above the upper lid margin when the lids are open, and it is obvious that very little effect can be expected there from drops alone under ordinary circumstances.

The following procedure will as a rule provide a satisfactory answer to this problem.

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