Leslie R Small1, Anat Galor, Elizabeth R Felix, Danielle B Horn, Roy C Levitt, Constantine D Sarantopoulos. 1. Department of Ophthalmology (L.R.S., A.G., E.R.F., R.C.L., C.D.S.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Ophthalmology, Miami Veterans Administration Medical Center (A.G.), Miami, FL; Physical Medicine and Rehabilitation (E.R.F.), University of Miami, Miami, FL; Department of Anesthesiology, Perioperative Medicine and Pain Management (D.B.H., R.C.L., C.D.S.), University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL.
Abstract
PURPOSE: There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity. METHODS: A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies. RESULTS: We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later. CONCLUSIONS: Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.
PURPOSE: There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity. METHODS: A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies. RESULTS: We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later. CONCLUSIONS: Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.
Authors: Harrison Dermer; Daniella Lent-Schochet; Despoina Theotoka; Christian Paba; Abdullah A Cheema; Ryan S Kim; Anat Galor Journal: Drugs Date: 2020-04 Impact factor: 9.546
Authors: Nandini Venkateswaran; Jodi Hwang; Andrew J Rong; Alexandra E Levitt; Ryan J Diel; Roy C Levitt; Konstantinos D Sarantopoulos; Wendy W Lee; Anat Galor Journal: Am J Ophthalmol Case Rep Date: 2020-07-04
Authors: Sneh Patel; Rhiya Mittal; Elizabeth R Felix; Konstantinos D Sarantopoulos; Roy C Levitt; Anat Galor Journal: Front Pharmacol Date: 2021-12-23 Impact factor: 5.810