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Aim-To evaluate sub-Tenon' s anaesthesia as an alternative to peribulbar anaesthesia. Methods-109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. Results-There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. Conclusion-Sub-Tenon's anaesthesia is an eYcient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia. (Br J Ophthalmol 1997;81:673-676) In addition, preoperative intravenous sedation is often required because patients find the injection painful and frightening. Recently there had been renewed interest in subTenon's anaesthesia. 10-12It is not a new technique since it was described as early as 1884 by Turnbull. 13 This prospective study reports our experience of sub-Tenon's anaesthesia using a blunt cannula for various anterior and posterior segment eye operations. Materials and methodsFrom February1996 to July 1996, 109 consecutive patients (47 males, 62 females with a mean age of 66) scheduled for peribulbar anaesthesia underwent surgery under subTenon's anaesthesia instead. Seventy six had phacoemulsification cataract extraction (temporal corneal or scleral tunnel incision), five underwent combined phacoemulsification with trabeculectomy, three pterygium removal, five trabeculectomy, six had a three port pars plana vitrectomy for dislocated fragments of lens in the vitreous following cataract surgery, three a pars plana vitrectomy for vitreous haemorrhage, three had silicone oil removal, one radial keratotomy, one secondary lens implantation, one artificial lens removal for chronic endophthalmitis, two hyphaema evacuation, and three necessitated surgical treatment of iris prolapse following cataract surgery.Duration of surgery, site of sub-Tenon's anaesthesia, conjunctival chemosis (0 = no chemosis; + = chemosis involving one quadrant; ++ = chemosis involving two quadrants; +++ = chemosis involving three or four quadrants), subconjunctival haemorrhage (0 = no haemorrhage; + = haemorrhage involving one quadrant; ++ = haemorrhage involving two quadrants; +++ = haemorrhage involving three or four quadrants) were all noted on a chart. Patients were asked to score the pain during the anaest...

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