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

Eric RH Duerr, Andrew Chang, Nandini Venkateswaran, Raquel Goldhardt, Roy C Levitt, Ninel Gregori, Konstantinos D. Sarantopoulos, Anat Galor

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)35-38
Number of pages4
JournalAmerican Journal of Ophthalmology Case Reports
Volume14
DOIs
StatePublished - Jun 1 2019

Fingerprint

Eye Pain
Intraocular Injections
Chronic Pain
Nerve Block
Pain
Photophobia
Diclofenac
Bupivacaine
Methylprednisolone
Retinal Detachment
Peripheral Nerves
Cyclosporine
Adrenal Cortex Hormones
Therapeutics
Injections

Keywords

  • Chronic ocular pain
  • Neuropathic ocular pain
  • Periocular nerve blocks

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "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.",
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AU - Chang, Andrew

AU - Venkateswaran, Nandini

AU - Goldhardt, Raquel

AU - Levitt, Roy C

AU - Gregori, Ninel

AU - Sarantopoulos, Konstantinos D.

AU - Galor, Anat

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N2 - 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.

AB - 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.

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