This study of 20 patients undergoing elective cataract surgery was performed to investigate the change in intraocular pressure that accompanies extraconal peribulbar anaesthesia. We have demonstrated that each injection during peribulbar anaesthesia causes a small rise in intraocular pressure. The routine use of conventional external ocular compression overcomes this pressure rise and safely provides a satisfactory and progressive reduction in intraocular pressure prior to surgery. Our findings suggest that the volumes of anaesthetic solutions used in fractional peribulbar anaesthesia, if used in conjunction with external compression devices, result in intraocular pressures acceptable for intraocular surgery.