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A.-M. Lobo, Y. I. Leiderman, L. J. Hart, S. Mukai; Use of Ultrasound Guidance and a Three-Way Stopcock for Retrobulbar Injection of Chlorpromazine in the Treatment of Blind, Painful Eyes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):283.
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Retrobulbar injection of chlorpromazine is effective in treatment of blind, painful eyes and can avoid enucleation. Placement of the drug into the muscle cone is important in increasing the efficacy and decreasing the complications from this procedure. Current techniques involve manipulation of the needle prior to injection, and there is uncertainty in the location of the tip of the needle at the time of injection. We devised a technique using ultrasound guidance and two-port injection using a three-way stopcock for retrobulbar injection.
An Atkinson retrobulbar needle was attached to a three-way stopcock device with two separate 3 ml syringes attached to connecting ports, one syringe containing chlorpromazine (25mg/ml) and the other with 4% lidocaine. B-scan ultrasonography was used in the guidance of the needle although it is often difficult to track the location of the needle tip by ultrasonography. The needle postion is confirmed by injecting a small amount of lidocaine which can be seen by ultrasonography. Once this is confirmed, chlorpromazine is injected followed by an additional amount of lidocaine using the three-way stopcock to change the ports. Retrobulbar injection of chlorpromazine was performed in five eyes in five patients treated for blind, painful eyes. The retrobulbar needle was advanced and its position within the intraconal space was visualized with ultrasound both before and after injection of 0.5ml of lidocaine. Once fluid was visualized within the muscle cone, the stopcock was redirected and 1ml of chlorpromazine was directly injected without further manipulation of the needle. Ultrasound was again used to visualize fluid after the injection of chlorpromazine.
We identified five eyes in five patients (three adults, two children) treated by this technique. Pediatric cases were performed under general anesthesia. Two cases required two injections. Enucleation was avoided in all cases with complete or partial pain control.
This technique of using ultrasound guidance and a three-way stopcock for accurate placement of retrobulbar injections of chlorpromazine provides an effective method for the management of blind, painful eyes, even in pediatric patients.
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