Topical analgesics for acute corneal pain: current options and emerging therapeutics

Abstract

Acute corneal pain is a common complaint that causes significant distress to patients and continues to challenge therapeutic avenues for pain management. Current topical treatment options have marked limitations in terms of both efficacy and safety, thus often prompting the adjunctive use of systemic analgesics, including opioids. In general, there have not been extensive advancements in pharmacologic options for the management of corneal pain over the past several decades. Despite this, multiple promising therapeutic avenues exist which hold the potential to transform the ocular pain landscape, including druggable targets within the endocannabinoid system. This review will summarize the current evidence base for topical nonsteroidal anti-inflammatory drugs, anticholinergic agents, and anesthetics before focusing on several potential avenues in the setting of acute corneal pain management, including autologous tear serum, topical opioids and endocannabinoid system modulators.

Neuropathic Corneal Pain after Coronavirus Disease 2019 (COVID-19) Infection

“…Topical administration of opioids might be more effective at avoiding potential side effects. A few studies have revealed that topical opioids reduced pain scores and increased rate of epithelial healing post-photorefractive keratectomy without deleterious effects [64,65]. A phase I study indicated the tolerability to escalating doses of topical naltrexone (1-4 eye drops at dosages up to 50 µM) in healthy individuals [66].…”