If he can the facial block must be repeated. There should be little or no movement of laris oculi muscle, which closes the eyelids, or in the extraocular muscles moving the eye are acceptable, but the importance of a good local anaesthetic block cannot be emphasized too strongly. The most common cause of complications and difficulties during intraocular surgery is a poor local anaesthetic block. The speculum is inserted to hold open the eyelids but not to force them open. The superior rectus suture is not to hold an eye which is turning up because of an inadequate local anaesthetic block.
Most surgeons make the incision at or near the limbus.
The limbus is probably the most popular place for the incision and is certainly the best place for an inexperienced surgeon. Incisions further back in the sclera will bleed excessively. Incisions further forward in the cornea do not heal so well. The sutures may also cause some irritation. However, a corneal incision should be used if the patient irritate the eye.