The sub-Tenon's space is the potential space between Tenon's capsule (the fibrous fascia enclosing the globe) and the underlying sclera. Tenon's capsule is a fascial sheath extending from the limbus anteriorly to the optic nerve posteriorly, attached to the rectus muscle sheaths. The sub-Tenon's space communicates with the episcleral space and allows the passage of fascial extensions that form the check ligaments of the extraocular muscles.
The sub-Tenon's space is the target for sub-Tenon's anaesthesia — injection of local anaesthetic through a small conjunctival and Tenon incision in the inferonasal quadrant into this space, where the anaesthetic spreads to block the posterior ciliary nerves and the motor branches to the extraocular muscles. It provides excellent surgical anaesthesia for cataract, vitreoretinal, and strabismus surgery without the risks of retrobulbar block (globe perforation, optic nerve injection, brainstem anaesthesia). Sub-Tenon's drug delivery is increasingly used for sustained-release corticosteroid implants for uveitis.
A small inferonasal conjunctival and Tenon's capsule incision allows a blunt cannula to enter the sub-Tenon's space where 3-5 mL of local anaesthetic spreads circumferentially around the globe, providing akinesia and analgesia for cataract and vitreoretinal surgery without the retrobulbar injection risk of globe perforation or optic nerve sheath injection.
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