Sir,

We are grateful to Harrad and Stoggart for their valuable observations made on the points raised in our paper.

We would also like to thank Singh and Stewart for their interest and response to our article. Although it is true that the relative risk of anaphylaxis to nondepolarizing muscle relaxants is high compared to other anaesthetic agents, it is a small risk in absolute terms (estimated to be 1:15 000–30 000 anaesthetics). We would argue this is considerably lower than the risk of sight-threatening intraoperative complication due to the eccentric eye.

They are also quite correct in that local anaesthesia infiltrations may relieve the problem. They also may not. Furthermore, peribulbar injections carry the risk of globe perforation.

We would maintain that our proposed solution is a reliable, reasonable and safe one, particularly when a ‘tincture of time’ is either unavailable or ineffective.