The vast majority of vitreoretinal procedures can be safely, comfortably, and efficiently performed under local anesthesia with minimal sedation. Compared with general anesthesia, properly performed monitored local anesthesia offers the patient an increased level of safety, reduced recovery times, and prolonged postoperative pain relief. Nonetheless, the choice of anesthesia technique must be based on the needs of the patient, the requirements of the surgeon, and the skills of the anesthesia provider, ever keeping in mind that our ultimate goal is a satisfied patient with a good visual outcome.