Name of the Procedure:

Retrobulbar Injection; Alcohol

Summary

A retrobulbar injection with alcohol involves injecting an alcohol solution directly into the retrobulbar space, which is the area behind the eye. This procedure is primarily used to alleviate chronic eye pain.

Purpose

This procedure addresses chronic, severe pain in or around the eye, often caused by conditions such as advanced eye disease or cancer. The goal is to provide long-term pain relief by numbing the nerves in the area.

Indications

• Chronic, severe eye pain unresponsive to other treatments
• Pain associated with blind eye (Phantom eye pain)
• Pain from advanced cancer involving the orbit
• Patients who are not candidates for surgery or other pain management techniques

Preparation

• Fasting may be required several hours before the procedure.
• Discontinuation of certain medications such as blood thinners, as advised by the doctor.
• Complete pre-procedural diagnostic tests like imaging studies to guide the injection.

Procedure Description

1. The procedure starts with the patient in a lying position.
2. The eye and surrounding area are cleaned with an antiseptic solution.
3. A local anesthetic is administered to numb the area.
4. Using a fine needle, the physician injects the alcohol solution directly into the retrobulbar space.
5. The injection is guided by ultrasound or other imaging techniques to ensure accurate placement.
6. The procedure generally takes a few minutes once the area is prepped and numbed.

Duration

The whole procedure typically takes about 20-30 minutes, including preparation and actual injection.

Setting

This procedure is performed in an outpatient setting, such as a hospital or an eye clinic.

Personnel

• Ophthalmologist or specialized pain management physician
• Nurse or medical assistant

Risks and Complications

• Common risks include bruising, swelling, and temporary discomfort at the injection site.
• Rare risks include infection, bleeding, damage to the ocular structures, or unintended nerve damage.
• Complications can often be managed with medications or additional treatments if they arise.

Benefits

• Significant and potentially long-lasting pain relief.
• Improvement in quality of life due to reduced pain.

Recovery

• Patients may experience mild discomfort immediately following the procedure.
• Cold compresses and over-the-counter pain relievers may be recommended.
• Normal activities can usually be resumed within a day or two.
• Follow-up appointments to monitor effectiveness and address any complications.

Alternatives

• Oral or topical medications, although they might have systemic side effects or limited efficacy.
• Nerve blocks using different agents.
• Surgical options such as neurectomy, which involves cutting the nerve causing pain.
• Consideration should be given to the pros and cons of each option in comparison to retrobulbar alcohol injection.

Patient Experience

• The patient might feel a brief stinging sensation from the local anesthetic injection.
• During the injection of alcohol, a pressure or mild burning sensation might be felt.
• Post-procedure, there may be slight soreness, but this typically resolves quickly with minimal discomfort.
• Pain relief can be almost immediate, with maximum benefit realized within days.