There is substantial national and international variation in the conduct of anesthesia for ophthalmic surgical procedures. Ophthalmic regional anesthetic techniques include traditional needle-based blocks, such as intraconal or extraconal injections; sub-Tenon's blocks which can be accomplished with needles, but are more commonly performed with blunt cannulae; and topical anesthesia. Needle-based techniques are generally safe although rare, serious sight- and life-threatening complications may occur. In recent years, a renewed interest in sub-Tenon's and topical anesthesia has emerged. Currently there is no absolutely safe ophthalmic regional block. It is essential that those who are involved in the care of ophthalmic patients have a thorough knowledge of the approaches employed and their associated risks and benefits. This review article outlines the relevant anatomy, commonly used techniques and their safe performance.