Surgeon: With proper preparation, technique, topical anesthesia may be effective for strabismus surgery

SAN FRANCISCO — Strabismus surgery performed under topical anesthesia is possible and may actually be advantageous, according to a speaker here.

Although topical anesthesia for strabismus surgery has previously been discredited, it may, with suitable preoperative planning, provide for a streamlined process, a sterile setup and optimal visualization during surgery, David K. Coats, MD, said at Pediatric Subspecialty Day preceding the American Academy of Ophthalmology meeting.

According to Dr. Coats, it is imperative that surgery be performed by an experienced, gentle surgeon with the aid of a skilled anesthesiologist "who can work with you should the patient experience discomfort."

In addition, Dr. Coats said it is imperative to only perform surgery on a willing patient. "If the patient seems squeamish, I wouldn't even try," Dr. Coats said.

Dr. Coats recommended using topical lidocaine gel in the holding area of both eyes, with intravenous propofol early on, if needed, as well as lidocaine drops as needed intraoperatively. Dr. Coats said he prefers to use a limbal incision and stressed the need to be satisfied with less than perfect exposure.

"The most important thing is, don't pull on the muscle, because that is what really causes the patient problems," Dr. Coats said.