Literature review of aspects relating to topical anaesthesia for strabismus surgery
Reviewed by Fiona Rowe

This review was undertaken to consider the benefits and limitations, the nuances in surgical techniques and the preoperative testing and counselling in patients considered suitable for topical anaesthesia strabismus surgery. Preoperative considerations were reported as age, tolerance of forced duction testing and surgeon experience. Preoperative counselling included the nature of medications, gels, drops, experience of pulling/tugging sensation and forced duction test tolerance. Timing of the administration of topical anaesthesia agents centred on instillation once on the operating table with repeated instillation after 5 minutes. Lignocaine was used most with top-ups. Typically, an anaesthetist was on hand if needed. Nuances in surgical technique considered discomfort and pain when hooking the muscle, incision choice, gentle hooking, avoiding traction, more drops before scleral bites, low luminance source, and avoidance of oblique muscle and superior rectus surgery because of larger surgical sites. Postoperative course considered one-stage surgery as preferable to general anaesthesia with later adjustable. Complications included issues with cooperation, the need to convert to peribulbar anaesthesia and issues with any strabismus surgery such as bleeding. Benefits and limitations were discussed including the immediate evaluation and ability to further adjust if needed, along with a quicker postoperative recovery. This surgical choice is limited to a certain population of patients. The authors conclude there is a niche role for topical anaesthesia strabismus surgery. This requires careful patient selection and counselling is crucial.

Topical anesthesia strabismus surgery.
Bhate M, Badakere A, Donaldson C.
STRABISMUS
2025;33(2):118–25.