Provided preservative-free solutions are used there are no undesirable effects. Although corneal toxicity has been reported in animal models, clinical studies have failed to demonstrate increased endothelial cell damage. Patient satisfaction with intraoperative analgesia after topical anaesthesia appears comparable to that of 'injection' techniques. Fortunately any differences are small and relate to increased discomfort rather than pain. Any discomfort is better tolerated if the patient is fully informed pre-operatively.
Intracameral injections reduce discomfort scores and improve patient satisfaction.
The successful use of acupuncture to supplement topical anaesthesia in cataract surgery has also been described but is unlikely to become standard practice. The demands on the surgeon and patient limit the use of topical anaesthesia to relatively short procedures. Occasionally a facial nerve block may be requested to reduce eyelid movements. A good surgeon-patient relationship facilitates the procedure. Communication with the patient whilst operating is a surgical skill that has to be acquired.