Eye surgery is the most common surgery in the elderly. Many ophthalmic procedures, such as cataract extraction can be performed safely in an outpatient setting, using regional anesthesia and mild sedation. The number of outpatient ophthalmic procedures will increase as the population continues to age. Advantages of regional anesthesia over general anesthesia are numerous; it is generally safer with less incidence of complications and less bleeding. Aim: The purpose of this thesis is to evaluate the use of ultrasonography in the performance of local anesthesia for ophthalmic surgery. This assessment includes whether ultrasound will add to the safety of the technique and its success rate. Patients and methods: After approval of our institutional ethics committee and obtaining a written informed consent, 100 adult patients having routine cataract extraction were divided randomly into: Group A (peribulbar anesthesia) and Group B (retrobulbar anesthesia), with 50 patients in each group. Each group was subdivided into two subgroups: In one the anesthesia was administered blindly, in the second using B-scan ultasonography, with 25 patients in each one. Patients randomly allocated to one of these four subgroups until the required number is reached in each group. Results: Results of the current study demonstrated comparable degree of globe akinesia after 10 minutes (p = 0.342). The majority of cases showed no globe movement after 10 minutes. Similarly, lid akinesia showed no significant difference between 4 groups (p = 0.082). This was accompanied by partial satisfaction of the majority of surgeons with the procedure; comparable in the 4 subgroups (p = 0.270). Conclusion: Peribulbar and retrobulbar regional anesthesia of the orbit during cataract surgery are safe procedures if blindly applied. Ultrasonography-guided needle injection doesn't add to the safety and/or efficacy of the procedure. Therefore, ultrasound guidance is not an advantage in orbital regional anesthesia; whether administered by the peribulbar or retrobulbar technique.