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Ophthalmic pain

Carl Bradbrook

Recognition and e ective treatment of ophthal- photophobia. hen treating ophthalmic pain, it
mic pain may present the clinician with a is important to consider the type of surgery to
challenge due to di culties in patient assess- be performed, as this is likely to allow the
ment. his may result from a combination of clinician to choose the most appropriate
factors including a lack of validated ocular pain methods to provide analgesia.
scales, altered patient temperament due to the he most commonly performed ophthalmic
presenting condition, and di culty in assessing procedures involve enucleation and surgery to
the periorbital area when painful. reatment the cornea and eyelids. Although provision of
relies on the recognition of pain followed by analgesia for intraocular surgery is ust as
e ective analgesia. As with any clinical situation important, it is beyond the scope of this text. As
where pain is suspected, analgesia should be well as treating pain associated with surgical
provided and the patient reassessed at an conditions, it is important to consider presenting
appropriate time. Provision of good analgesia ophthalmic conditions that may re uire pain
improves anaesthetic stability and, most management prior to further medical or surgical
importantly, patient comfort. Incorporation of intervention. Corneal ulceration, often
local anaesthesia techni ues, where appropriate, secondary to corneal drying, entropion,
along with more traditional methods is likely to distichiasis or ectopic cilia, is extremely painful
improve e cacy of analgesic treatment. and re uires good analgesia.
Clinical signs of ophthalmic pain include Analgesics suitable for treatment of ocular
blepharospasm, excessive tearing, photophobia, pain include opioids, non steroidal anti
and head shyness. Clinical signs may be in ammatory drugs NSAI s and local
dependent on the structures involved, such as anaesthetics. Additional analgesia may be
the cornea, con unctiva, adnexal or intraocular provided using ketamine and the alpha
structures. or example, most ophthalmic agonists, although the possibility of these drugs
conditions will lead to blepharospasm and head increasing I P should be considered. ue to
shyness, but pain associated with intraocular this, the use of ketamine or alpha agonists is
disease may result in an increase in intraocular not advised with a fragile eye or during
pressure I P , which is more likely to result in intraocular surgery.

142 BSAVA Guide to Pain Management in Small Animal Practice. Edited by Ian Self. ©BSAVA 2019

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