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Published online by Cambridge University Press: 12 January 2010
Numerous types of surgical intervention can be performed in the treatment of diseases of the eye and its adnexa. Owing to the great degree of technical skill required to execute these interventions, subspecialists perform a significant portion of ophthalmic surgeries. Microsurgery is involved in all procedures and most of the operations are limited to intervention into the eye and orbit with minimal risk to other organs. Ophthalmic surgery offers a high probability of success with a major positive impact on the quality of life. However, many patients with eye pathology are elderly and some have significant systemic illness, so the risk of elective intervention must be balanced against expected benefits. Optimal preoperative management of medical problems can make surgery safer and minimize patient discomfort.
Anesthesia
The large majority of ophthalmic interventions can be performed under local anesthesia with intravenous sedation. In some cases, even topical anesthetics are sufficient. Ophthalmic surgeries that require general anesthesia are those that involve significant extraocular manipulation in regions where a local anesthetic is not effective, and those that are prolonged as occurs in many vitreoretinal and orbital procedures as well as some cosmetic operations. General anesthesia is also indicated in younger patients and individuals who may not remain motionless during surgery and trauma cases with significant ocular laceration where administration of local anesthetics may raise intraorbital pressure with consequent extrusion of intraocular contents.
Several choices exist in the route of administration of local ophthalmic anesthesia for intraocular surgery.
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