We thank Dr Shinder for his encouraging comments on our manuscript highlighting the efficacy of lidocaine 2% gel for achieving anesthesia in patients undergoing microkeratome-assisted LASIK. We also support his observation that 2% lidocaine gel is superior to topical anesthetic drops since it provides “robust anesthesia for both the bulbar and palpebral conjunctiva.” Adequate intraoperative analgesia is pertinent for a safe surgical procedure. Lidocaine gel has been widely used in urogenital, laryngotracheal, and skin anesthesia and nowadays an increasing number of ophthalmic surgeons are using lignocaine gel as a viable topical anesthetic agent for a wide variety of surgeries, including phacoemulsification, chalazion excision, intravitreal injections, pterygium excision, and refractive surgery. Besides cataract and refractive surgery, the published data on the use of topical anesthesia in ophthalmology are sparse. Ophthalmic surgeons are encouraged to expand the indications for using lignocaine gel in other subspecialties as well as share their experiences. We had previously published the successful use of lignocaine 2% gel during pterygium, strabismus and chalazion, and laser surgery. The use of gel offers increased comfort to the patient and does not require significant supplementary anesthetic eye drops.

We found that when it is employed in patients undergoing LASIK, the analgesic effect of lignocaine gel lasts up to at least 45 minutes postoperatively. This is most likely related to the prolonged action of lignocaine gel. It is important, however, that the anesthetic gel is thoroughly washed away from the ocular surface before proceeding with LASIK. Any residual gel on the corneal surface may potentially cause flap-related complications such as thin flaps or intraoperative epithelial defects. We would welcome additional studies with long-term follow-up of patients in order to underscore any latent adverse effects of gel anesthesia in refractive surgery candidates. Also, with the increase in popularity of femtosecond-assisted LASIK, further studies with larger sample sizes are warranted in order to analyze the safety and efficacy of topical anesthetic gel in these procedures.