Medial Canthus (Caruncle) Periocular Anesthesia

This technique is commonly used as an adjunct to Peribulbar anesthesia when the primary anesthesia lost the effects.

A 26-gauge, short bevel needle is inserted in the semilunaris fold, between the globe and the lacrimal caruncula.The needle is then shifted slightly medially, displacing the caruncula medially away from the globe until a “click” is perceived. Then, the globe came back to the primary gaze position. This movement possibly corresponds to the passage through the “medial check” ligament. I like to use maximum 1,5 ml lidocaine + 1,5 ml bupivacaine.

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