I read with great interest the recent report by Lam and associates describing decreased patient subjective pain during LASIK when supplemental 2% lidocaine gel was topically applied. For some time now as an oculoplastic surgeon, I have utilized 2% lidocaine gel for anesthesia of the conjunctiva and have found it to be superior to topical anesthetic drops. Lidocaine gel provides robust anesthesia for both the bulbar and palpebral conjunctiva, aiding in various procedures of the ocular adnexa.

Pterygium excision with conjunctival autograft may be performed using only topical 2% lidocaine gel anesthesia with great intraoperative and postoperative patient comfort. Similarly, conjunctival biopsies and excisions can be safely done with lidocaine gel. The benefits in both cases are avoiding systemic anesthetics for the patient, and the ability to perform such procedures in an office setting.

When performing anterior debulking of prolapsed orbital fat or dermolipomas, lidocaine gel can also be utilized to anesthetize the conjunctiva. In these cases, the surgeon can carry out transconjunctival dissection until the adipose tissue of interest is grasped, solely with gel anesthesia. The lesion can then be injected with lidocaine containing epinephrine for anesthesia and hemostasis purposes just prior to debulking. The advantage of this technique is that subconjunctival lidocaine injection is not needed prior to conjunctival dissection, which tends to displace the fatty tissue posteriorly, making intraoperative dissection toward the lesion more challenging. Additionally, less total injectable anesthetic can be used, postoperative subconjunctival hemorrhage is less severe, and again the procedure can comfortably be performed in an office setting without the need for systemic anesthesia.

Finally, when performing office-based eyelid procedures a potential method for lid anesthesia is to first anesthetize the palpebral conjunctiva with lidocaine gel and then provide full-thickness lid anesthesia via a transconjunctival injection of lidocaine, passing the needle through the already anesthetized conjunctiva. Patient subjective pain using this anesthetic method may be less than traditional lid anesthesia via subcutaneous local anesthetic injection.

I applaud the authors for highlighting a potential use for 2% lidocaine gel during LASIK, and welcome the readership to expand their current utilization of lidocaine gel for conjunctival anesthesia during ocular adnexal and anterior segment procedures.