Transconjunctival versus transcutaneous local anaesthetic administration for lower eyelid surgery: a randomised controlled trial

Aim To compare the associated discomfort and safety between transcutaneous (Tskin) and transconjunctival (Tconj) approaches of local anaesthetic (LA) administration in lower eyelid surgery. Methods A prospective randomised controlled trial comparing Tskin and Tconj LA in patients undergoing bilateral lower eyelid surgeries for horizontal laxity. Patients were randomised to receive LA via Tskin to one side and Tconj to the fellow side. LA injection was administered in a slow fashion accompanied by distraction (tapping of patient's forehead). Self-reported discomfort from the injections was rated using a 0-10 numerical rating scale. A single blinded assessor graded photographs for eyelid bruising (0 = absent, 1 = mild, 2 = moderate, 3 = severe). Results A total of 30 patients (mean age ± SD, 75.9 ± 6.7 years) were enrolled. The overall pain score (mean ± SD) was statistically lower for the Tconj than the Tskin group (3.90 ± 2.28 versus 5.33 ± 2.23, p = 0.017). More patients in the Tconj group reported substantially less pain (score of ≤3) in comparison to the Tskin group (56.7% versus 23.3%, p = 0.017). In individual patients, the Tconj pain score was found to be significantly lower than the Tskin side (p = 0.008). Bruising scores were higher in the Tskin group, but this was not statistically significant (p = 0.13). No other adverse effects were found. Conclusion Tconj delivery of LA in lower eyelids with horizontal laxity is safe and associated with less discomfort and bruising than the conventional Tskin route. Trial registration number NCT04102878.