During the last 20 years, the practice of eye surgery has changed radically and regional ophthalmic anesthesia took the upper hand in many ocular surgeries. In this essay, we discussed a detailed knowledge of the anatomy of the bony orbit and the globe, especially of the nerve supply to the orbital structures, which is essential to obtain effective regional blocks. Knowledge of ocular physiology including the formation and drainage of aqueous humour and its influence on intraocular pressure, awareness of the oculocardiac reflex, and many of the anesthetic agents adversely affect the IOP during surgery are of great importance to the anesthetist and so discussed in details. General anesthesia provides good control of IOP during surgery and allows immobile surgical field therefore; it is indicated for any eye surgery for children, as it is unreasonable to expect co-operation or understanding from infants and young children. On the other hand IOP may increase during intubation and extubation, and postoperative nausea and vomiting is more common. Significant proportions of patients requiring ophthalmic surgery are infants, and children. Careful preoperative assessment is very important in these groups, as many congenital eye abnormalities are accompanied by many other congenital anomalies. Also, old age is associated with many physiological changes, which affect the cardio-pulmonary, hepatic, and renal functions, as well as the general metabolism. This also requires careful preoperative assessment and preparation, and so good anesthetic management. A variety of ophthalmic procedures, for example; cataract extraction, corneal transplantation, lid surgery, and even vitrectomy or repair of retinal detachment can be performed safely using regional anesthesia and mild sedation therefore, in this essay we discussed sedation techniques in ophthalmic surgery. Also, we discussed the different techniques of regional anesthesia; the most recent technique Episcleral “Sub-tenon’s” Anesthesia is also discussed. Complications of regional ophthalmic anesthesia have been discussed in details. Finally, the advantages of regional anesthesia for eye surgery are mentioned and compared with general anesthesia with special emphasis on their value in reducing cost, morbidity and mortality rates of ophthalmic anesthesia, and its suitability for day-case surgery which becomes popular in ophthalmic field, thus it is advisable whenever possible unless it is ontraindicated.