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 Table of Contents    
LETTERS TO THE EDITOR
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 190-191  

Retrobulbar alcohol injection: A forgotten therapy for management of painful blind eye


1 Department of Ophthalmology, Rustaq Regional Hospital, Rustaq, Oman
2 Department of Anatomy and Physiology, Kasturba Medical College, Manipal, Karnataka, India
3 General Practioner, Rustaq Polyclinic, Rustaq, Oman

Date of Web Publication28-May-2018

Correspondence Address:
Jagdish Bhatia
Department of Ophthalmology, Rustaq Hospital, P. O. Box: 421, PC 329, Rustaq
Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.OJO_198_2017

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How to cite this article:
Bhatia J, Narayanadas B, Varghese M, Faruk M, Hafez AA, Bhatia N, Bhatia A. Retrobulbar alcohol injection: A forgotten therapy for management of painful blind eye. Oman J Ophthalmol 2018;11:190-1

How to cite this URL:
Bhatia J, Narayanadas B, Varghese M, Faruk M, Hafez AA, Bhatia N, Bhatia A. Retrobulbar alcohol injection: A forgotten therapy for management of painful blind eye. Oman J Ophthalmol [serial online] 2018 [cited 2019 Dec 13];11:190-1. Available from: http://www.ojoonline.org/text.asp?2018/11/2/190/233310



Sir,

Painful blind eyes are usually associated with or secondary to corneal decompensation with bulla formation, absolute glaucoma, neovascular glaucoma, and ocular trauma. Retrobulbar alcohol has been used to provide relief to patients with painful blind eyes since long, but the popularity of this therapy has declined among the ophthalmologist in recent times. It provides near instantaneous and continual relief.[1] The alcohol infiltrates the long and short posterior ciliary nerves and provides analgesia by destruction of nerve cells.[2]

The success of retrobulbar alcohol injection is variable, ranging from 20% to 87% of patients.[3] However, retrobulbar alcohol injection can lead to temporary blepharoptosis, external ophthalmoplegia, cellulitis, neurotrophic keratopathy, eyelid edema, conjunctival chemosis, and complications related to the retrobulbar injection technique itself.[4],[5]

This retrospective case series was conducted at our ophthalmic department, from 2013 to 2016. Patients with a painful eye but with perception of light or better vision were not included in the study. Indication for selecting these cases for retrobulbar alcohol injection in our series was neovascular glaucoma in 4 cases [Figure 1], absolute glaucoma in 2 cases, and healed perforated corneal ulcer with secondary endophthalmitis in 1 case. The mean age was 72 years (with standard deviation of 12.8 years). Five patients were females and two were males [Table 1]. All the patients had unbearable pain of variable duration with no perception of light vision. Full disclosure of the procedure with outcome was explained to all the cases in their language, and an informed consent was taken. Procedure was performed in outpatient department.
Figure 1: Patient with painful blind eye due to neovascular glaucoma

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Table 1: Demographic data of the study

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With this potentially repeatable technique, a 25-gauge retrobulbar needle with 40 mm length was passed into the retrobulbar space at the junction of medial two-third with lateral one-third of lower orbital margin and 2 ml of 2% xylocaine was injected [Figure 2]. After an interval of 2–3 min, 2 ml of absolute (100%) alcohol was injected through the same needle. Postinjection, all the patients were given supportive treatment for few days (oral diclofenac, topical steroids, atropine, and topical antibiotic ointment). All the patients were followed up 1 day after the procedure, then after 1 week, and then every month. The mean follow-up period in our series was 18 months (with standard deviation of 15.92 months).
Figure 2: Injecting 2 ml of 2% xylocaine in retrobulbar space

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All the patients developed mild eyelid edema and conjunctival chemosis within 24 h which resolved within a week. We do not report any other significant complication during or after the procedure. At the end of the 1st week after injection, 6 out of 7 (85.7%) patients were pain free and did not required supportive analgesics. We did repeat the procedure in one of the patients with perforated healed corneal ulcer with secondary endophthalmitis after 1 month as desired result was not obtained with the first injection and a patient was not willing for evisceration. Repeat injection of retrobulbar alcohol too did not work in this patient and the patient ultimately agreed for evisceration.

In patients with severe intractable pain in a blind eye, primary focus of the management is the pain relief. The enucleation or evisceration may not be the answer if the patient is psychologically not ready to agree for destructive surgery or has cosmetically acceptable blind eye. In this situation, we can perform the retrobulbar block with absolute alcohol as one of valuable alternatives. In our series, pain relief provided by retrobulbar alcohol was rapid and long lasting in all patients except the one. This is comparable to the results of other studies.[2],[3],[6]

In our opinion, retrobulbar injection of absolute alcohol is a useful tool in our therapeutic armory for those with blind, painful eyes in which enucleation or evisceration is refused or inadvisable.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Merbs SL. Management of a blind painful eye. Ophthalmol Clin North Am 2006;19:287-92.  Back to cited text no. 1
[PUBMED]    
2.
Al-Faran MF, Al-Omar OM. Retrobulbar alcohol injection in blind painful eyes. Ann Ophthalmol 1990;22:460-2.  Back to cited text no. 2
[PUBMED]    
3.
Maumenee AE. Retrobulbar alcohol injections; relief of ocular pain in eyes with and without vision. Am J Ophthalmol 1949;32:1502-8.  Back to cited text no. 3
[PUBMED]    
4.
May DR, May WN. Decreasing discomfort caused by retrobulbar alcohol injection. Am J Ophthalmol 1983;95:262-3.  Back to cited text no. 4
[PUBMED]    
5.
Olurin O, Osuntokun O. Complications of retrobulbar alcohol injections. Ann Ophthalmol 1978;10:474-6.  Back to cited text no. 5
[PUBMED]    
6.
Çok OY, Eker HE, Cantürk S, Yaycioǧlu R, Ariboǧan A, Arslan G, et al. Pain management in blind, painful eyes: Clinical experience with retrobulbar alcohol injection in 4 cases. Agri 2011;23:43-6.  Back to cited text no. 6
    


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