The authors present a technique that combines topical and subconjunctival anaesthesia for vitreoretinal surgery. In this ‘two-step’ procedure, three drops of proparacaine were applied to the conjunctival fornix, followed by subconjunctival lidocaine injected in three quadrants. This was compared with conventional peribulbar and retrobulbar techniques. Ninety patients undergoing surgery for various vitreoretinal conditions were randomly allocated to receive peribulbar, retrobulbar or ‘two-step’ anaesthesia. Patients were asked to grade their pain levels during surgery using a visual analogue scale, and their surgeons were asked to grade their level of discomfort while operating. There was no significant difference between the three techniques in terms of intraoperative or postoperative pain, nor in surgeon discomfort. Predictably, ocular motility was significantly higher in the ‘two-step’ group than the peribulbar or retrobulbar groups. However, as this technique obviates many of the risks of regional anaesthesia, it may be useful for selected patients and in procedures less dependent on akinesia.