Keywords
Pain
Retrobulbar injection
Absolute alcohol
Chlorpromazine
Visual Analogue Scale
How to Cite
Abstract
Background: Many eye diseases may end up with a painful blind eye. Different management options
have been used to alleviate the pain and maintain the globe. Topical medications are frequently used as
conservative treatment. Retrobulbar injection of neurolytic agents like alcohol, chlorpromazine (CPZ) or
phenol are other medical options that can be considered.
Objectives: Comparing the efficacy and safety of retrobulbar absolute alcohol with chlorpromazine
injection in the treatment of painful blind eyes.
Methods: A double masked trial in which patients with painful blind eye, aged 18 years or above, were
randomized to receive either a retrobulbar injection of 2ml of absolute alcohol (96%) or 2ml of CPZ (25mg/
ml), both with 2ml of lidocaine (2%). Visual Analogue Scale (VAS) is used to objectively measure intensity
of pain and level of pain relief after the intervention.
Results: A total of 84 eyes of 84 patients were injected with either absolute alcohol (n=43) or CPZ (n=41).
Thirty nine from alcohol group and 35 participants from the CPZ group appeared for third month followup
evaluation. Sixth month response was also evaluated in 30 and 26 participants from alcohol and CPZ
groups, respectively. The mean and standard deviation in VAS pain reduction was 57.9 mm (±32.17) in
the alcohol group and 55.4 mm (±31.26) in the CPZ group (P value= 0.734). Based on the improvement in
pain intensity 30 patients (79.6%) from absolute alcohol group and 28 patients (80.0%) from CPZ group
had significant pain relief after the 3rd month of injection. Statistically significant mean IOP reduction was
noted in CPZ group compared to the alcohol group: mean IOP (in mm Hg) reduction at 3rd month was
13.0 vs 2.5 (P-value 0.009). Immediately after the injection complications like burning sensation (20 vs 8),
ptosis (2 vs 0) and retrobulbar haemorrhage (0 vs 2) were noticed in alcohol and CPZ group respectively.
Lid swelling, external ophthalmoplegia, ptosis, chemosis and skin necrosis were the type of complications
observed later on. All the immediate and subsequent complications had resolved spontaneously.
Conclusions and recommendation: Efficacy of pain reduction with retrobulbar injection of absolute
alcohol and chlorpromazine was comparable. The choice of retrobulbar injection between the two agents
also needs to consider availability and cost. Further study is required to evaluate long term efficacy and
safety.
References
Philip C, Chet R. Enucleation of blind, painful
eyes. Ophthalmol Plastic Recons Surg. 2000; 16
(5):326–329.
Al-Faran MF, Al-Omar O. Retrobulbar alcohol
injection in blind painful eyes. Ann Ophthalmol.
; 22:460–462.
Custer L, Reistad E. Enucleation of blind, painful
eyes. Ophthalmol Plast Reconstr Surg. 2000; 16:326-344.
Chen TC, Ahn Yuen SJ, Sangalang MA, et al.
Retrobulbar chlorpromazine injections for the
management of blind and seeing painful eyes.
J Glaucoma. 2002; 11 (3): 209-213.
Birch M, Strong N, Brittain P, et al. Retrobulbar
phenol injection in blind painful eyes. Ann
Ophthalmol. 1993; 25: 267–270.
Estafanous MFG, Kaiser PK, Baerveldt G.
Retrobulbar chlorpromazine in blind and seeing
painful eyes. Retina. 2000; 20: 555–558.
Fiore C, Lupidi G, Santoni G. Effet de l’injection
retrobulbaire de chlorpromazine dans le glaucome
absolu. J Fr OphtHalmol. 1980; 3: 397–399.
Bastrikov NI. Symptomatic treatment of terminal
painful glaucoma by the retrobulbar administration
of aminazin. Vestn Oftalmol. 1989; 105:47–49.
Price DD, McGrath PA, Rafii A, Buckingham B.
The validation of visual analogue scales as ratio
scale measures for chronic and experimental pain.
Pain. 1983; 17: 45-56.
Price D, Harkins W. The combined use of
visual analogue scales and experimental pain in
providing standardized assessment of clinical
pain. Clin J Pain. 1987; 3: 3-11.
Mark P. Jensen, Connie Chen, and Andrew M.
Brugger Interpretation of Visual Analog Scale
Ratings and Change Scores. © 2003 by the
American Pain Society.
Olurin O, Osuntokun O. Complications of
retrobulbar alcohol injections. Ann Ophthalmol.
; 10: 474–476.
Maumenee AE. Retrobulbar alcohol injections:
relief of ocular pain in eyes with and without
vision. Am J Ophthalmol. 1949; 32: 1502–1508.
Fejer J. The treatment of painful absolute glaucoma
and other eye diseases with retrobulbar injections
of alcohol. Am J Ophthalmol. 1932; 15:135–136.
Indeikina GV. Retrobulbar injections of aminazin
during cupping in acute attacks of terminal
glaucoma. Oftalmol Zh. 1987; 21:122–123.