Regional nerve block of the upper eyelid

Most contemporary oculoplastic surgery is performed under local anesthesia (1). The move away from general anesthesia has proved both efficient and cost effective, as all but the more major eyelid surgery can now be performed as a day-case pro c e d u re. Local anesthesia also has the advantage of allowing patient cooperation during surgery, which can aid in the prediction of postoperative outcomes. In most upper lid pro c e d u res, the local anesthetic is usually administered by an infiltrative technique into the subcutaneous and deeper tissues. Although this method usually provides adequate anesthesia, it produces distortion of the tissues and runs the risk of producing bleeding in the operative site, which further distorts the anatomy, making accurate surgery more difficult. When operating on the upper lid, accurate postoperative lid height is an important goal. When comparing postoperative upper lid height immediately after surgery to final height achieved, there is often a discrepancy. Factors explaining this difference include the mechanical effect of the local anesthetic and hemorrhage on the lid, and paralysis of the orbicularis and levator muscles by local diffusion of the anesthetic. A regional nerve block given away from the operative E u ropean Journal of Ophthalmology / Vol. 16 no. 4, 2006 / pp. 5 0 95 1 3