Malik et al.1 are to be congratulated on their excellent review of the current status of cataract anesthesia. As one who trained when cryoextraction was "best practice" and has subsequently progressed to small-incision phacoemulsification, I am surprised there was no mention of a very simple and safe local anesthetic technique that I have used for 20 years. Although I call it "perilimbal infusion," it is in essence a variant on the time-honored subconjunctival block. I use a dental cartridge of lidocaine with epinephrine. A couple of drops are placed on the eye. After a minute, a small conjunctival bleb is raised just below the limbus using a 25-gauge needle. I wait an additional minute and then reintroduce the needle into the (now shallow) bleb and slowly inject 1.0 cc. This will diffuse around the entire limbus, giving the appearance of chemosis. The injection is painless and provides excellent anesthesia/akinesia for an hour. (I am a slow surgeon and if the case is challenging, I may need this duration.)
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