Asunto(s)
Cocaína , Oftalmopatía de Graves , Humanos , Oftalmopatía de Graves/complicaciones , Oftalmopatía de Graves/diagnóstico , Oftalmopatía de Graves/cirugía , Órbita/diagnóstico por imagen , Órbita/cirugía , Ceguera/diagnóstico , Ceguera/etiología , Trastornos de la Visión , Descompresión QuirúrgicaRESUMEN
PURPOSE: To report a case of chronic neuropathic ocular pain in a patient without visual complaints. OBSERVATIONS: A 37-year-old male with a history of bilateral laser-assisted in situ keratomileusis (LASIK) presented with pain symptoms of 8 months duration in the left eye. The prior LASIK surgery was complicated by corneal ectasia in the left eye requiring penetrating keratoplasty and subsequent placement of a glaucoma drainage implant for uncontrolled, elevated intraocular pressure. The patient was evaluated with a complete clinical examination, including Goldmann applanation tonometry, dilated fundus examination, fluorescein angiography, optical coherence tomography, and magnetic resonance imaging. After 3 weeks of treatment with gabapentin 300 mg BID, the patient reported complete resolution of the ocular pain. CONCLUSIONS AND IMPORTANCE: The pathophysiology of neuropathic ocular pain remains poorly understood. Clinical evaluation often reveals minimal ophthalmic exam findings, leading to an underdiagnosis of the condition by ophthalmologists. Gabapentin may be an underutilized medication in the treatment of chronic ocular pain.
Asunto(s)
Acetaminofén/administración & dosificación , Analgésicos Opioides/administración & dosificación , Hidrocodona/administración & dosificación , Procedimientos Quirúrgicos Oftalmológicos , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Acetaminofén/uso terapéutico , Analgésicos Opioides/uso terapéutico , Combinación de Medicamentos , Humanos , Hidrocodona/uso terapéutico , Proyectos Piloto , Estudios Retrospectivos , AutoinformeRESUMEN
The authors report the use of a 0.35-mm-thickness nylon implant for medial orbital wall reconstruction to facilitate functional endoscopic sinus surgery (FESS) for severe erosive polypoidal sinus disease while minimizing iatrogenic injuries to the orbital contents. A retrospective chart review identified 4 patients with extensive polypoidal sinus disease who underwent medial orbital wall reconstruction in the setting of FESS. All patients underwent successful reconstruction of bilateral eroded medial orbital walls using a 0.35-mm Supramid Foil Nylon Implant immediately followed by FESS. There were no permanent complications or iatrogenic injuries to the orbital contents due to FESS. All patients experienced improvement in sinus symptoms. Medial orbital wall reconstruction in the setting of erosive polypoidal sinus disease is a useful tool to help facilitate FESS. It allows the sinus surgeon to clear sinus disease aggressively with the orbits being protected from iatrogenic injury.