Treatment of Ocular Neuralgia After Refractive Surgery With Bilateral Orbital Steroid and Anesthetic Injections

Treatment of Ocular Neuralgia After Refractive Surgery With Bilateral Orbital Steroid and Anesthetic Injections

Yalamanchili S P; Hertle R W

Journal of Refractive Surgery

2019

2019-08

PURPOSE: To describe a patient with chronic periocular pain after bilateral photorefractive keratectomy (PRK), termed ocular neuralgia, that was controlled with regular orbital steroid and anesthetic injections. METHODS: Case report. RESULTS: A 21-year-old man presented 3 months following bilateral PRK surgery in severe bilateral orbital pain. Previous treatments included topical (artificial tears, corticosteroids, and nonsteroidal anti-inflammatory drugs [NSAIDs]) and oral (NSAIDs, opioids, and pregabalin) therapies with minimal pain relief. A bilateral orbital triamcinolone acetonide 40 mg/cc and 0.25% bupivacaine injection was done after a successful, diagnostic unilateral 0.25% bupivacaine injection. Following bilateral bupivacaine and triamcinolone acetonide injections, pain intensity improved from 7 to 9 to 1 to 3 (out of 10). Repeat injections have been regularly performed over the past 3 years, allowing the patient to experience improved symptoms lasting from 4 to 9 months. CONCLUSIONS: Regular orbital nerve blocks can provide relief from neuralgic ocular pain and may be considered as a potential treatment option after failure of medical management.

efficacy; management; Neuropathic pain; Ophthalmology; Surgery

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