Resolution of pain with periocular injections in a patient with a 7-year history of chronic ocular pain

Abstract

Purpose We report a case of a male patient with chronic ocular pain that resolved completely following peripheral nerve blocks. Observations A 66-year-old male presented with a seven-year history of severe left eye pain and photophobia. The pain began after retinal detachment repair with scleral buckle placement. Previous treatments included topical (autologous serum tears, corticosteroids, diclofenac, cyclosporine) and oral (gabapentin, diclofenac) therapies with no pain relief. The patient's pain was so severe that he requested enucleation. After discussion, the decision was made to perform periocular nerve blocks. Prior to the procedure, the patient reported an average pain intensity of 8 out of 10 and photophobia daily. Following left supraorbital, supratrochlear, infraorbital and infratrochlear injections with bupivacaine and methylprednisolone, pain intensity and photophobia improved to 1–2 out of 10. One week later, repeat infraorbital and infratrochlear nerve blocks were given, after which time the patient reported complete resolution of symptoms that lasted for 7 months. Repeat nerve blocks were administered with repeat resolution of pain. There were no complications associated with the procedures. Conclusions and Importance Chronic ocular pain can be a debilitating condition. Periorbital nerve blocks can provide pain relief and should be considered as a potential treatment option after medical management has failed.

Ocular Surface Pain: A Narrative Review

“…These improvements were variable, lasting from hours to months [ 100 ]. In addition to other case reports [ 21 , 100 , 114 ], this study supports the use of periocular nerve blocks in the management of refractory ocular surface pain.…”

Novel Treatments for Chronic Ocular Surface Pain

“…53 These findings were substantiated by a case report of a 66-year-old male patient with NOP (evidenced by extreme photosensitivity, mechanical hyperalgesia, periocular pain with allodynia to light touch, unremarkable slit-lamp examination, and refractory response to topical and oral medications) who reported substantial relief in symptoms for 7 months after treatment. 73 Similarly beneficial effects were reported after a single bilateral nerve block in a 21-yearold man who developed severe bilateral ocular pain 3 months after PRK with improvement in pain intensity to a score of 2 of 10 from baseline scores of 8 of 10, (range 0-10), with beneficial effects lasting for 3 weeks. Repeat injections performed over 3.5 years showed improved symptom intensity lasting 4 to 6 months.…”

Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation

“…Nevertheless, prior studies demonstrated that while evidence-and guidelinebased prescribing led to a reduction in the amount of opioids prescribed, it did not result in increased refill requests. 7,20,22,23 Future studies should assess the adequacy of pain relief and use of nonnarcotic medications as well as further investigate the effect of statewide opioid legislation on the risk of opioid misuse and opioid-related morbidity and mortality.…”