Phaco Tip 96:
Topical Anesthesia and the Photophobic Patient:
The NLP Technique

During topical anesthesia, an occasional patient will be unable to cooperate due to severe photophobia. These sensitive individuals cannot tolerate even the lowest microscope light setting, and the associated Bell's reflex causes the globe to become inaccessible due to supraduction. To overcome this problem, make a small stab incision at the inferior limbus, then slowly inject non-preserved lidocaine until the IOP becomes very high. The patient will immediately become NLP due to nonperfusion of the central retinal artery. Photophobic symptoms will immediately disappear, and the patient will be able to comfortably cooperate and gaze straight ahead as the clear corneal incision is created. Light perception will immediately return when the globe is entered, although at a somewhat diminished level, and the phaco procedure can be performed in the usual fashion.

* Phaco Tip TM of Richard J. Mackool, M.D.

The parameters (instrument settings) and incision size presented here have been established by the surgeon and do not reflect recommendations by Alcon.