Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients’ anxiety was assessed using the State–Trait Anxiety Inventory—State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025.

Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interven-tions offer a promising non-pharmacological approach to perioperative anxiety man-agement. This study evaluated the effectiveness of superimposed binaural beats (SBB)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autograft. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autograft under local anesthesia were allocated to one of three groups: SBB, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory in-terventions. Anxiety was assessed using the State-Trait Anxiety Inventory-State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBB is a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Its integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial.