Resolution of pain with periocular injections in a patient with a 7-year history of chronic ocular pain

Abstract

Purpose: We report a case of a male patient with chronic ocular pain that resolved completely following peripheral nerve blocks.

Observations: A 66-year-old male presented with a seven-year history of severe left eye pain and photophobia. The pain began after retinal detachment repair with scleral buckle placement. Previous treatments included topical (autologous serum tears, corticosteroids, diclofenac, cyclosporine) and oral (gabapentin, diclofenac) therapies with no pain relief. The patient's pain was so severe that he requested enucleation. After discussion, the decision was made to perform periocular nerve blocks. Prior to the procedure, the patient reported an average pain intensity of 8 out of 10 and photophobia daily. Following left supraorbital, supratrochlear, infraorbital and infratrochlear injections with bupivacaine and methylprednisolone, pain intensity and photophobia improved to 1-2 out of 10. One week later, repeat infraorbital and infratrochlear nerve blocks were given, after which time the patient reported complete resolution of symptoms that lasted for 7 months. Repeat nerve blocks were administered with repeat resolution of pain. There were no complications associated with the procedures.

Conclusions and importance: Chronic ocular pain can be a debilitating condition. Periorbital nerve blocks can provide pain relief and should be considered as a potential treatment option after medical management has failed.

Keywords: Chronic ocular pain; Neuropathic ocular pain; Periocular nerve blocks.

Fig. 1

Slit lamp photograph of left eye demonstrating radial keratotomy scars, an 80% oil fill in the anterior chamber, a surgical iris, and aphakia.

Fig. 2

Slit lamp photograph of left eye demonstrating neovascularization of the cornea into the radial keratotomy scars and central band keratopathy.

Fig. 3

Representative external photographs demonstrating location of nerve blocks: A) pictorial of nerve branches; B) supraorbital nerve block; C) supratrochlear nerve block; D) infraorbital nerve block; E) infratrochlear nerve block through same injection site as infraorbital block achieved by repositioning needle.