Complications of retrobulbar anesthesia are rare but significant. Periocular anesthesia has been advocated as an alternative to retrobulbar injections. In a prospective, randomized, masked study of 79 consecutive cataract extractions with intraocular lens implantations, 40 patients received retrobulbar injections and 39 patients received periocular injections. In every instance, the volume of the injection was 5 mL. No significant difference in surgeon's assessment of akinesia and anesthesia was found. Supplemental anesthesia was required in eight (21%) of the patients who received retrobulbar injections and in 11 (28%) of the patients who received periocular injections. A significant increase in chemosis was found with periocular injections. There was one complication with retrobulbar anesthesia and none with periocular anesthesia. No significant difference in patient assessment of comfort was found. The efficacy of periocular anesthesia appears to be comparable to that of retrobulbar anesthesia.