Abstract
Purpose: :
To evaluate the efficacy of 0,5% chlorpromazine retrobulbar injection for pain management in patients with chronic painful eyes.
Methods: :
In this prospective study, chlorpromazine was injected in the retrobulbar space of 17 painful eyes of 17 patients, in the Department of Ophthalmology of the Santa Casa Medical School Hospital, in São Paulo, Brazil.Out of the 17 studied patients, 9 (52.94%) were male and 8 (47.06%) female. The average age was 48.18 ± 20.02 years (range 13 to 80 years). Sixteen eyes (94.12%) presented no light perception and 1 (5.88%) light perception. The average follow-up period was 10.06 ± 7.69 months (range, 3 to 24 months). The patients presented severe eye pain despite of conventional treatment, which consisted of corticosteroids and atropine eye drops and oral nonsteroidal anti-inflammatory. They were submitted to retrobulbar injection of a mixture of 1mL of 0,5% chlorpromazine and 1 mL of 2 % lidocaine hydrochloride. The eye was occluded for 12 hours after the injection. The same doctor performed all injections. The presence of pain during the application and the appearance of adverse symptoms in the following 30 minutes were recorded, period in which the patients remained under observation.After 7, 30 and 90 days, and in the last follow-up, the patients were evaluated and ranked according to the evolution of pain in three groups:1. absence of pain2. some pain relief3. no pain reliefWe defined as successful pain control the absence or relief of pain found in the last evaluation.
Results: :
The treatment was successful in 16 out of 17 patients (94.12%). One (5.88%) patient required re-injection of chlorpromazine due to the lack of pain control. No patient referred pain during the application. The complications were infrequent and included 2 cases (11.77%) of intense somnolence within hours of duration and 1 case (5.88%) of weakness, holocranial headache, paleness, sweating, nausea and vomit, with improvement within a few minutes after resting in supine position. In the first days after the application we found transient palpebral edema and chemosis in 5 patients and hyphosfagma in one case. After one month 1 patient presented a corneal ulcer and after three months another patient presented total hyphema. It was not necessary to perform enucleation in any of the patients.
Conclusions: :
The retrobulbar injection of 0,5% chlorpromazine, a five times lower concentration than the used in previous studies, was effective in pain relief of chronic painful eyes, presenting few side effects.
Keywords: orbit • inflammation • innervation: sensation