Survey maps how equine vets use retrobulbar anaesthesia
Bottom line
A new cross-sectional survey in Equine Veterinary Journal offers a broad snapshot of how veterinarians are using retrobulbar anaesthesia in standing, sedated horses for ocular surgery. The study, led by Simona Lieberth and colleagues at Freie Universität Berlin, collected responses from 238 veterinarians in 25 countries, most of them specialty-college members. Enucleation was by far the most common indication, the dorsal approach was the technique used most often, and 4-point blocks were the next most common. Mepivacaine, lidocaine, and bupivacaine were the drugs reported most frequently. Respondents also reported that lack of anaesthesia, exophthalmos, chemosis, and retrobulbar haemorrhage were among the more common complications, while severe complications were rare. The authors found that technique choice and complication patterns varied significantly with the clinician’s background and equine caseload. (beva.onlinelibrary.wiley.com)
Why it matters: For equine practitioners, the paper gives real-world benchmarking on how retrobulbar blocks are being performed outside controlled studies. That’s useful because standing ophthalmic surgery continues to expand as clinicians try to avoid the higher risks associated with general anaesthesia in horses, and prior work has focused more on cadaver models or technique development than on everyday clinical use. The survey suggests that “standard practice” is still heterogeneous, especially around approach selection, ultrasound guidance, and expectations for complications, which could shape training, case selection, and informed discussions with pet parents about procedural risk. (beva.onlinelibrary.wiley.com)
What to watch: Expect follow-on work to focus on whether ultrasound-guided or alternative periocular techniques can improve consistency and reduce complication rates in live clinical cases. (onlinelibrary.wiley.com)
Key facts
- Study type
- Cross-sectional survey
- Journal
- Equine Veterinary Journal
- Sample size
- 238 veterinarians
- Countries represented
- 25 countries
- Most common indication
- Enucleation
- Most used technique
- Dorsal approach
- Next most common technique
- 4-point blocks
- Most reported drugs
- Mepivacaine, lidocaine, and bupivacaine
- Common complications
- Lack of anaesthesia, exophthalmos, chemosis, and retrobulbar haemorrhage
A newly published global survey is giving equine veterinarians a clearer view of how retrobulbar anaesthesia is actually being used in practice for standing ocular surgery. In the Equine Veterinary Journal study, Simona Lieberth and colleagues surveyed 238 veterinarians across 25 countries and found that the dorsal approach dominates current use, with 4-point blocks a distant second. The paper also shows that complication profiles and technique choices aren’t uniform: they shift depending on the practitioner’s professional background and how heavily their caseload is weighted toward horses. (beva.onlinelibrary.wiley.com)
That matters because retrobulbar anaesthesia sits at the intersection of two important trends in equine care: the push toward standing procedures when possible, and the need for dependable ocular analgesia and akinesia in a species where general anaesthesia still carries meaningful risk. The study notes that standing ophthalmic surgery has become more feasible as sedation and local anaesthetic protocols have improved. Earlier work has examined the safety and effectiveness of specific retrobulbar approaches, including dorsal and ultrasound-guided techniques, but much of that evidence has come from cadaver studies or smaller experimental settings rather than broad clinical experience. (beva.onlinelibrary.wiley.com)
In the survey, enucleation was reported as the leading indication for retrobulbar anaesthesia, cited by 97.8% of respondents. Corneal surgery followed at 29.5%, while eyelid procedures, paracentesis, cataract surgery, and vitrectomy were each used by fewer than 10% of respondents. The dorsal approach was used by 88.8% of participants, compared with 34.8% for 4-point blocks, 8.9% for lateral blocks, and 2.2% for modified Peterson blocks. Ultrasound-assisted needle positioning was reported by 16.1% of respondents, suggesting that image guidance remains a minority practice despite growing interest in ultrasound-guided regional techniques. (beva.onlinelibrary.wiley.com)
The medication patterns were also fairly concentrated. Mepivacaine was the most commonly reported local anaesthetic, followed by lidocaine and bupivacaine. On complications, the survey found that lack of anaesthesia, exophthalmos, chemosis, and retrobulbar haemorrhage were reported relatively often, but the authors emphasized that most complications were mild and severe events were rare. One of the more useful findings for clinicians was that background mattered: as the proportion of equine work in a respondent’s caseload increased, dorsal injection use fell, injection-related complications rose, and postoperative complications fell. That doesn’t prove causation, but it does suggest that experience, case mix, referral bias, or technique selection may all influence outcomes in practice. (beva.onlinelibrary.wiley.com)
There doesn’t appear to be much published public commentary on the survey yet, but the broader literature helps frame the result. A 2022 Equine Veterinary Journal study found that retrobulbar lidocaine injection via the supraorbital fossa was safe in adult horses, while also showing that periocular anaesthesia can be regionally variable. Separate cadaver studies have reported that ultrasound-guided dorsal retrobulbar blocks can improve needle placement accuracy and that ultrasound-guided peribulbar approaches may offer an alternative with potentially lower risk to critical orbital structures. Taken together, that literature helps explain why the survey found ongoing diversity in technique choice rather than a single universal standard. (beva.onlinelibrary.wiley.com)
Why it matters: For veterinary professionals, this survey is less about declaring a winning technique and more about defining the current field. It gives practices a reference point for how peers are approaching standing equine ophthalmic surgery, what drugs they’re selecting, and which complications they’re most likely to encounter. That can support protocol review, resident and intern training, and more precise consent conversations with pet parents. It also highlights a familiar gap in equine anaesthesia research: clinicians are making decisions in a space where real-world adoption has outpaced high-quality comparative outcome data. (beva.onlinelibrary.wiley.com)
The survey may also prompt a closer look at who is doing these blocks and under what circumstances. If equine-heavy clinicians are seeing more injection-related complications but fewer postoperative complications, that could reflect more advanced case selection, higher procedural volume, or greater willingness to tackle difficult ophthalmic cases in the standing horse. For referral hospitals and specialty services, that nuance is important: complication rates in the literature may not translate cleanly across practice settings, and training pathways may need to account for both technical skill and case complexity. (pubmed.ncbi.nlm.nih.gov)
What to watch: The next step is likely more prospective comparison of blind versus ultrasound-guided retrobulbar techniques, and possibly broader evaluation of peribulbar alternatives in live horses. If those studies can tie technique choice to block success, complication severity, and surgical conditions in clinical patients, they could move the field from expert preference toward stronger evidence-based standardization. (onlinelibrary.wiley.com)