Retrobulbar blocks serve to anesthetize and paralyze the eye during vitreoretinal surgical procedures. In this episode, we review the basic principles and two techniques for administering a retrobulbar block: needle block and subtenon’s block. Retrobulbar blocks, particularly needle blocks, can be associated with numerous risks including retrobulbar hemorrhage, globe perforation, optic nerve damage and spinal anesthesia (which can be life-threatening). Subtenon’s blocks are a safer alternative and can be safely and comfortably administered on a routine basis. Subtenon’s blocks should be particularly considered in patients with a long axial length and who are on anticoagulation, to mitigate the risks of globe perforation and retrobulbar block, respectively.
