Local Administration of Methylcobalamin and Lidocaine for Acute Ophthalmic Herpetic Neuralgia: A Single-Center Randomized Controlled Trial

Abstract

Objectives: To determine the therapeutic efficacy of combined methylcobalamin and lidocaine for acute ophthalmic herpetic neuralgia (AOHN).

Methods: Based on the onset, patients with AOHN (n = 98) were randomly allocated into groups A (≤ 3 days) and B (4 to 7 days) and then subdivided into control (A0, B0; received intramuscular methylcobalamin in addition to local lidocaine injection) and treatment (A1, B1; received local injection of the methylcobalamin and lidocaine combination for 14 days) groups. Treatment efficacy was assessed based on rash healing time, alteration of pain intensity, and interference with quality of life. Multilevel modeling and survival analysis were performed.

Results: The time (hours) to start and full opening of the affected eye and the time (hours) to start and full crusting were significantly reduced in both treatment groups (P < 0.05 vs. controls). The mean pain scores in A1 (2.6 ± 0.7) and B1 (1.2 ± 0.8) decreased significantly compared with those in A0 (7.0 ± 1.7) and B0 (5.6 ± 1.9), and the difference between the two therapeutic strategies significantly increased over time. The median minimum intervention time was 6 days in B1 and 11 days in A1. The incidence of postherpetic neuralgia (PHN) was 2.04% at 3 months.

Conclusions: Methylcobalamin combined with lidocaine mediated detumescence and improved cutaneous healing of the affected area, as well as a significant and sustained analgesic effect on AOHN. The incidence of PHN was also significantly decreased. Local methylcobalamin intervention within 4 to 7 days of onset may be an effective therapeutic option for AOHN.

Keywords: acute ophthalmic herpetic neuralgia; herpes zoster; methylcobalamin; randomized clinical trial; subcutaneous injection.