Pain management in blind, painful eyes: Clinical experience with retrobulbar alcohol injection in 4 cases

Abstract

Ocular pain is often difficult to treat and may be caused by many eye diseases. First step in pain management is medical therapy combined with analgesics, however severe and resistant cases may require neurolytic eye blocks or definitive surgery. The retrobulbar block with neurolytic agents such as alcohol may be preferred, if the eye is cosmetically normal or the patient is medically or psychologically unsuitable for enucleation or evisceration. Here, we present successful and efficient pain management with retrobulbar alcohol injection in 4 patients with painful blind eyes. The patients with neovascular glaucoma presenting with painful blind eyes were accepted to our clinic for pain management. The patients had continuous pain with an increasing severity in the last months. We planned to perform retrobulbar alcohol injection as the pain of the patients were resistant to medical therapy and we noted measurement of verbal analogue scale for pain (VAS) before the block (7, 9, 9 and 10, respectively), after retrobulbar lidocaine and alcohol injection, at postoperative 1st day, 1st,2nd 3rd and 4th week, 3rd, 4th, 5th, 6th and 12th months. We also noted the early and late complications. On the first day after injection, no patient required additive analgesic therapy and their VAS scores were 0, 0, 0 3, respectively.Except a patient who underwent enucleation because of a bacterial infection, others’ VAS scores were 1, 0 and 1 at 12th months’ assessment. We suggest that neurolytic retrobulbar block is an efficient pain management strategy in blind painful eyes.