Download PDF
Klin Monbl Augenheilkd 2025; 242(04): 492-494
DOI: 10.1055/a-2516-8629
Der interessante Fall

Pain Management Using Retrobulbar Ethanol Injection in Chronic Orbital Pain

Fallbericht: Schmerztherapie mittels retrobulbärer Ethanol-Injektion bei chronischen Orbitaschmerzen
Maximilian Felix Jacobi
1   Ophthalmology, University Hospital Zürich, Switzerland
,
Niklas Folke Kristian Winkler
1   Ophthalmology, University Hospital Zürich, Switzerland
2   Augenklinik, Talacker Augenzentrum Zürich (TAZZ), Switzerland
,
Sadiq Said 
1   Ophthalmology, University Hospital Zürich, Switzerland
3   Department of Ophthalmology, Augenklinik Wettingen, Switzerland
,
Sandrine Zweifel
1   Ophthalmology, University Hospital Zürich, Switzerland
,
Daniel Barthelmes 
1   Ophthalmology, University Hospital Zürich, Switzerland
,
Frank Blaser
1   Ophthalmology, University Hospital Zürich, Switzerland
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

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.



Publication History

Received: 27 October 2024

Accepted: 12 January 2025

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • 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
    CrossrefPubMedSearch in Google Scholar
  • 2 Custer PL, Reistad CE. Enucleation of blind, painful eyes. Ophthal Plast Reconstr Surg 2000; 16: 326-329
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 6 Grüter W. Rückblick auf die bisherigen Erfahrungen mit der orbitalen Alkoholinjektion nach Grüter. Graefes Arch Ophthalmol 1941; 144: 92-128
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 9 Schittkowski MP. Alkoholinjektion bei chronischem orbitalem Schmerz nach Enukleation – Falldarstellung und Literaturübersicht. Klin Monbl Augenheilkd 2017; 234: 20-25
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 11 al-Faran MF, al-Omar OM. Retrobulbar alcohol injection in blind painful eyes. Ann Ophthalmol 1990; 22: 460-462
    PubMedSearch in Google Scholar
  • 12 Kostadinov I, Hostnik A, Cvenkel B. et al. Brainstem Anaesthesia after Retrobulbar Block. Open Med (Wars) 2019; 14: 287-291
    CrossrefPubMedSearch in Google Scholar
  • 13 Chin YC, Kumar CM. Brainstem anaesthesia revisited: Mechanism, presentation and management. Trends Anaesth Crit Care 2013; 3: 252-256
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 15 Michels RG, Maumenee AE. Retrobulbar alcohol injection in seeing eyes. Trans Am Acad Ophthalmol Otolaryngol 1973; 77: OP164-OP167
    PubMedSearch in Google Scholar