Background and Objectives The authors report the first prospective randomized comparison of the medial canthus single-injection peribulbar anesthesia (also called caruncular anesthesia) with the classic double-injection peribulbar technique.

Methods One hundred patients scheduled for cataract surgery were randomly assigned to either a single medial canthus injection or a double peribulbar injection of mepivacaine 2%. The amount of anesthetic agent injected was clinically adapted to each patient. Akinesia, volume injected, pain, reinjections, and complications were assessed after the procedure.

Results The medial canthus single-injection peribulbar anesthesia was significantly less painful and required less anesthetic agent than the double-injection peribulbar anesthesia. Akinesia score and the reinjection rate were similar in the 2 groups, whereas chemosis was significantly more frequent in the double-injection group.

Conclusions Medial canthus single-injection peribulbar anesthesia appears to be an effective alternative to the usual double-injection peribulbar anesthesia.