Background: In squint and buckle surgeries, the intraoperative pain of muscle traction might not be completely prevented by local anesthetic (LA) drugs. Adding fentanyl to LA can avoid systemic opioids side effects. Objectives:The aim of the current work was to evaluate the safety and efficacy of adding fentanyl to peribulbar block to abolish or decrease muscle traction pain during squint or buckle operations. Patients and methods: This randomized clinical trial study included a total of 60 adult patients (18–65-year-old) of both genders booked for either squint or scleral buckle surgeries, attending at Research Institute of Ophthalmology, Giza, Egypt. Patients were allocated randomly into two groups (30 patients each); fentanyl group and control group. Intraoperative pain was the primary outcome, whereas secondary outcomes included the onset of complete akinesia andpatient satisfaction. Results: The median pain score was 1 for both groups. Two patients of the fentanyl group and 5 patients of the control group required general anesthesia. The mean time to achieving complete akinesia was shorter in the fentanyl group with a significant statistical difference (134.2±35.8 vs. 156.3±34.7, p = 0.018). The patient satisfaction was more with fentanyl use but with no statistical significance. Conclusions: It could be concluded that fentanyl added to the local anesthesia mixture of peribulbar block in squint and scleral buckle surgeries shorten the time needed to achieve complete akinesia. However, it does not improve the intraoperative pain resulting from muscle traction. Also, it does not affect the need for general anesthesia or postoperative patient satisfaction.