Periocular nerve blocks for the treatment of ocular pain

Abstract

Purpose : To evaluate the efficacy of periocular nerve blocks for the treatment of ocular pain.

Methods : Retrospective review of charts.

Results : Three individuals were identified who presented with ocular pain and were treated with one or multiple periocular nerve blocks for presumed neuropathic ocular pain. Their ages ranged from 54 – 71 years. Two were male, one female. All three subjects had inciting factors for their pain, this included peri-orbital trauma, LASIK and a trans-sphenoidal resection of a pituitary adenoma. All subjects underwent an ophthalmic examination to rule out ocular surface or other ocular disease as the underlying cause. Two subjects responded to treatment with total relief of eye pain; one subject reported no improvement in pain after injection. Subject 1 had a history of LASIK and a mullerectomy resulting in pain in her left eye and adjacent supra- and infraorbital regions that ranged from 2-6/10 intensity and did not resolve with topical ophthalmic anesthetic. Treatments included warm compresses, artificial tears and lifitegrast without relief. Ibuprofen and acetaminophen relieved pain temporarily. Meloxicam provided mild relief. The final treatment was a left supratrochlear, a supraorbital and a infraorbital nerve block that resulted in complete resolution of symptoms (0/10 pain). Subject 2 presented with shooting pain along the left trigeminal distribution as well as tactile allodynia after a trans-sphenoidal resection of a pituitary adenoma 4 years prior. Treatment tried without success included gabapentin, pregabalin, tricyclic antidepressants, carbamazepine, and zonisamide. A dorsal balloon gangliolysis rhizotomy provided pain relief for a few weeks. Infraorbital and supratrochlear nerve blocks were performed resulting in complete pain relief. Subject 3 had persistent pain of the lower eyelid (right V2 / infraorbital trigeminal distribution) after a minor trauma to the eye not involving the globe. The pain descriptor was a foreign body sensation (FBS) and photophobia in the right eye. The FBS did not resolve with topical ophthalmic anesthetic. Treatments tried included artificial tears, topical corticosteroids, topical diclofenac, pregabalin, and gabapentin. Right infraorbital trigeminal V2 nerve block was performed. The patient reported no improvement in FBS or photophobia.

Conclusions : Two of three individuals experienced complete ocular pain relief after periocular nerve blocks.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.