Pain Management Using Retrobulbar Ethanol Injection in Chronic Orbital Pain

Background

Orbital pain is triggered by the stimulation of the ophthalmic division of the trigeminal nerve [1]. The list of possible causes is extensive and includes trauma, orbital processes such as orbital cellulitis or thyroid orbitopathy, sinusitis, vascular diseases such as orbital or cavernous sinus pathologies, optic neuritis, intracranial disorders such as pseudotumor cerebri, or perineural tumor infiltration [2], [3]. Chronic orbital pain can severely limit a patientʼs quality of life. Unlike most causes of ocular pain, such as recurrent corneal erosions, acute angle closure, or neovascular glaucoma, there is often no causal treatment option for orbital pain [4].

Retrobulbar ethanol injection is a long-established method of pain suppression in chronic ocular and orbit pain, be it from any of the causes mentioned above [4], [5]. The first use of retrobulbar ethanol was reported by Grüter as early as 1918 [6]. However, this method has rarely been applied in recent decades due to other better treatment options such as glaucoma surgery or adjuvant chemo-/radiotherapy), as well as more advanced systemic pain medications. This case report aims to further raise awareness about retrobulbar ethanol injection as a viable treatment option for severe orbital pain.

Publikationsverlauf

Eingereicht: 27. Oktober 2024

Angenommen: 12. Januar 2025

Artikel online veröffentlicht:
16. April 2025

• References

• 1 Voirol JR, Vilensky JA. The normal and variant clinical anatomy of the sensory supply of the orbit. Clin Anat 2014; 27: 169-175
• 2 Custer PL, Reistad CE. Enucleation of blind, painful eyes. Ophthal Plast Reconstr Surg 2000; 16: 326-329
• 3 Brazis PW, Lee AG, Stewart M. et al. Clinical review: the differential diagnosis of pain in the quiet eye. Neurologist 2002; 8: 82-100
• 4 Kumar CM, Dowd TC, Hawthorne M. Retrobulbar alcohol injection for orbital pain relief under difficult circumstances: a case report. Ann Acad Med Singap 2006; 35: 260-265
• 5 Akhtar N, Tayyab A, Kausar A. et al. Pain management with retrobulbar alcohol injection in absolute glaucoma. J Pak Med Assoc 2015; 65: 678-680
• 6 Grüter W. Rückblick auf die bisherigen Erfahrungen mit der orbitalen Alkoholinjektion nach Grüter. Graefes Arch Ophthalmol 1941; 144: 92-128
• 7 Bhatia J, Narayanadas B, Varghese M. et al. Retrobulbar alcohol injection: A forgotten therapy for management of painful blind eye. Oman J Ophthalmol 2018; 11: 190-191
• 8 Galindo-Ferreiro A, Akaishi P, Cruz A. et al. Retrobulbar Injections for Blind Painful Eyes: A Comparative Study of Retrobulbar Alcohol Versus Chlorpromazine. J Glaucoma 2016; 25: 886-890
• 9 Schittkowski MP. Alkoholinjektion bei chronischem orbitalem Schmerz nach Enukleation – Falldarstellung und Literaturübersicht. Klin Monbl Augenheilkd 2017; 234: 20-25
• 10 Çok OY, Eker HE, Cantürk S. et al. Pain management in blind, painful eyes: clinical experience with retrobulbar alcohol injection in 4 cases. Agri 2011; 23: 43-46
• 11 al-Faran MF, al-Omar OM. Retrobulbar alcohol injection in blind painful eyes. Ann Ophthalmol 1990; 22: 460-462
• 12 Kostadinov I, Hostnik A, Cvenkel B. et al. Brainstem Anaesthesia after Retrobulbar Block. Open Med (Wars) 2019; 14: 287-291
• 13 Chin YC, Kumar CM. Brainstem anaesthesia revisited: Mechanism, presentation and management. Trends Anaesth Crit Care 2013; 3: 252-256
• 14 Nanda T, Ross L, Kerr G. A Case of Brainstem Anesthesia after Retrobulbar Block for Globe Rupture Repair. Case Reports in Anesthesiology 2021; 2021: 2619327
• 15 Michels RG, Maumenee AE. Retrobulbar alcohol injection in seeing eyes. Trans Am Acad Ophthalmol Otolaryngol 1973; 77: OP164-OP167