Local anesthesia is widely used in ophthalmic surgery to provide effective analgesia and akinesia. This study aimed to compare the effectiveness and safety of lidocaine mixed with adrenaline versus lidocaine alone during ophthalmic surgery. A comparative observational study was conducted between January and May 2026 at the Noor Al-Khaleej Medical Center, Anwar Al-Khaleej Medical Center in Zawia, Surman Teaching Hospital, Surman Central Hospital, Al-Ajilat Eye Hospital, Zawia Al-Dahmani Eye Hospital - Tripoli, and Royal Clinic - Zawia. A total of 44 Libyan patients were included: Group A received lidocaine mixed with adrenaline (n = 22) and Group B received lidocaine alone (n = 22). Surgery duration was significantly shorter in Group A (27.50 vs. 41.14 min; p = 0.001). Preoperative and postoperative blood pressure and preoperative blood glucose were comparable between the groups, whereas postoperative blood glucose was significantly higher in Group A (135.32 vs. 107.73 mg/dL; p = 0.010). Analgesia and central eye position were similar in both groups. Group A demonstrated significantly better eye akinesia (81.8% vs. 45.5%; p = 0.022), body akinesia (54.5% vs. 31.8%; p = 0.028), and combined eye and body akinesia (68.2% vs. 22.7%; p = 0.006). No significant differences were observed in intraoperative complications, including chemosis, subconjunctival hemorrhage, iris prolapse, or corneal edema. In conclusion, adding adrenaline to lidocaine enhanced motor blockade and shortened surgical duration while maintaining a safety profile comparable to that of lidocaine alone during ophthalmic surgery.