Painful-blind eye: A forgotten palliative care

Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.

Treatment Effect and Pain During Treatment With Intense Pulsed-Light Therapy According to the Light Guide in Patients With Meibomian Gland Dysfunction

PURPOSE

We investigated whether there is a difference in the treatment effect and pain during the treatment of meibomian gland dysfunction (MGD) with intense pulsed-light (IPL) between new light guide and conventional light guide.

METHODS

We retrospectively reviewed medical records of 85 patients (170 eyes) who underwent IPL treatment of the upper and lower eyelids 3 times, at 3-week intervals, for MGD. Patients treated with the 6-mm or 8 × 15-mm cylindrical light guide were designated as group A or group B, respectively. The ocular surface disease index (OSDI), dry eye (DE), and MGD parameters were obtained before the first and after the third IPL treatments. Visual analog scale (VAS) scores were obtained at every IPL treatment. OSDI, DE, and MGD parameters and VAS scores were compared between the groups.

RESULTS

VAS scores at the first, second, and third IPL treatments were lower in group A than in group B. OSDI, DE, and MGD parameters were improved after 3 IPL treatments in both groups. There were no significant differences in OSDI, DE symptoms, and MGD parameters between before the first IPL treatment and after the third IPL treatment between the groups.

CONCLUSIONS

Using the new 6-mm cylindrical light guide for IPL treatment in patients with MGD induced less pain during treatment and had similar treatment effects to the conventional 8 × 15-mm light guide. The new 6-mm cylindrical light guide can be useful when treating patients with dark or hyperpigmented skin and for pediatric patients with low compliance.

[Corneal perforation due to 'lost' contact lenses]

An 87-year-old woman with Alzheimer's disease was referred to our eye clinic with a large corneal perforation of her right eye. On further examination a total of 15 contact lenses were found under the upper eyelid of her right eye; several lenses were also found in her left eye. During further evaluation we learned that our patient had experienced severe, recurrent and painful blepharoconjunctivitis for the past 3 years, for which she had consulted several ophthalmologists and other medical practitioners. The last time our patient had inserted a contact lens was more than 3 years previously. We therefore concluded that the retained contact lenses had caused an infectious ulcer which led to a corneal perforation. The patient underwent a perforating keratoplasty, which restored the eyesight in her right eye. Removal of the retained contact lenses gave our patient relief from her severe chronic eye pain.

Unusual presentation of subretinal cysticercosis with hypopyon uveitis

Subretinal cysticercosis presenting with anterior uveitis and hypopyon is rare. A 7-year-old boy presented with pain and hypopyon in the right eye. Ultrasonography showed a cystic lesion with scolex. Because visual prognosis was poor, he was treated conservatively. Timely diagnosis would facilitate early therapy and prevent visual loss.

Comparative evaluation of Comfilcon A and Senofilcon A bandage contact lenses after transepithelial photorefractive keratectomy

PURPOSE

To evaluate and compare Comfilcon A and Senofilcon A silicone hydrogel contact lenses used as a therapeutic bandage following transepithelial excimer laser photorefractive keratectomy (PRK).

METHODS

Patients undergoing transepithelial PRK for myopia were prospectively recruited. Included patients had a Comfilcon A silicone hydrogel lens inserted in one eye, with a Senofilcon A lens in the contralateral eye. Postoperative assessment of subjective pain, epithelial healing and visual recovery was at day 1, 3 and 7. Contact lens factors including centration, movement and deposits were assessed.

RESULTS

48 eyes of 24 patients were included in the study. Mean age was 31 years (SD 11) and mean refractive error -4.5 D (SD 1.8). Mean pain score at day 1 was significantly higher in the Comfilcon group at 4.6 (SD 2.7) vs. 1.5 (SD2.5) in the Senofilcon group (P<0.005). Mean time to healing was 3.17 days (SD 0.37) in the Comfilcon group, and 3.21 days (SD 0.4) in the Senofilcon group, with no difference in defect size. There was a pronounced central raphe in 1 eye in the Comfilcon group vs. 5 eyes in the Senofilcon group (P=0.19). Significantly more eyes demonstrated no lens movement in the Senofilcon group (18 vs. 4, P=0.0001).

CONCLUSION

The variation in material characteristics and lens geometry of different silicone hydrogel lenses affects their clinical characteristics in therapeutic roles. Other factors than oxygen permeability may affect pain and epithelial healing, with superior pain relief from the less permeable Senofilcon lens in this study.

Ocular manifestations in porphyria cutanea tarda

A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.

Eye pain: 5 cases to test your skill

The ability to distinguish between ophthalmic emergencies and benign eye conditions is crucial for a family physician. Find out how your skills stack up.

Pain management in blind, painful eyes: clinical experience with retrobulbar alcohol injection in 4 cases

Ocular pain is often difficult to treat and may be caused by many eye diseases. The first step in pain management is medical therapy combined with analgesics; however, severe and resistant cases may require neurolytic eye blocks or definitive surgery. Retrobulbar block with neurolytic agents such as alcohol may be preferred, if the eye is cosmetically normal or the patient is medically or psychologically unsuitable for enucleation or evisceration. Here, we present our successful and efficient pain management using retrobulbar alcohol injection in 4 patients with painful blind eyes. Patients with neovascular glaucoma presenting with painful blind eyes were accepted to our clinic for pain management. The patients had continuous pain with an increasing severity in the recent months. We planned to perform retrobulbar alcohol injection as the pain of the patients was resistant to medical therapy. We noted measurement of verbal analogue scale for pain (VAS) before the block (7, 9, 9 and 10, respectively), after retrobulbar lidocaine and alcohol injection, at the postoperative 1st day, 1st, 2nd 3rd and 4th weeks, and 3rd, 4th, 5th, 6th and 12th months. Early and late complications were also recorded. On the first day after injection, no patient required additive analgesic therapy and their VAS scores were 0, 0, 0, and 3, respectively. Except for one patient who underwent enucleation because of a bacterial infection, the other three patients' VAS scores were 1, 0 and 1 at the 12th month assessment. We suggest that neurolytic retrobulbar block is an efficient pain management strategy in blind painful eyes.