Fig. 3. Performing medial canthus episcleral anesthesia. (A ) The bevel of the needle is inserted in the conjunctiva between the semilunaris fold and the globe. Before advancing, the needle is shifted medially to go away from the globe and pull the fascial sheath of the orbit (Tenon’s capsule) and the conjunctiva, which are joined at this level. (B ) The needle is advanced strictly posteriorly. The traction on the fascial sheath of the eyeball causes the globe to rotate nasally. (C ) After a “click” is perceived, the globe returns to the primary gaze position. This indicates the passage through the fascial sheath of the eyeball to enter into the episcleral space. An aspiration test is performed, followed by small lateral movements, to ensure that the needle is moving independently from the eyeball (no globe perforation). Injection then is performed. Reprinted with permission. 46