SECO Course Explains Approach Treating Ocular Pain

Ocular pain is a complex manifestation that can be treated, in the short-term, by oral and topical agents — but with the caveat that, when prescribing opioids, optometrists need to be keenly aware of state restrictions.. In “Practical Management of Ocular Pain,” presented at the Southeastern Educational Congress of Optometry (SECO) 2021 meeting, Jessica Steen, OD, offered guidance on both the clinical and the practical aspects of ocular conditions for which pain management may be necessary.

The primary goal for primary eye physicians is to “find and treat the underlying cause,” Dr Steen explained — and then to manage associated pain. 

“Reduce (not eliminate) pain to restore functionality,” her presentation slide said.

Dr Steen also addressed the ocular sensory pathway, and how the mechanism of pain in the first, second, and third order neurons leads to the complex experience of pain. 

The World Health Organization’s (WHO) ladder approach to pain management details the first step: nonopioid medications (such as nonsteroidal anti inflammatory drugs [NSAIDs] and topical NSAIDs, and acetaminophen) for mild pain, with or without with or without adjuvants. “Adjuvants enhance analgesics [and] may be prescribed to control side effects,” she explained. The second step is weak opioids (like codeine) for moderate pain with or without non-opioid analgesics, and with or without adjuvants. The third, and final step, is potent opioids (like morphine) for severe and persistent pain.

In detail, Dr Steen discussed the first and second steps in pain management with slides on specific medicine types, including generic/brand names, dosages, side effects, and cautions. To manage pain in the first step“aim to treat on a fixed-dose schedule around the clock vs pro re nata,” or as needed, she said.

Other options are possible too, including 1.5 mL preservative free tetracaine 1%, dispensed in 24 hours, considered “a safe and effective means of controlling ocular pain” a study found. And in a case study, Dr Steen gives an example of pain management, a 38-year-old Hispanic male who presented with 3-day history of tearing, redness, and irritation in the right eye. The patient suspected he got a foreign object in his eye at work. It was removed, and the patient received 1 drop of 5% homatropine instilled in the office, was prescribed topical antibiotic (Polytrim QID), and recommended to take over the counter ibuprofen (2 x 200mg every 4 hours).

Reference

Steen J. Practical management of ocular pain.  Presented at: Southeastern Educational Congress of Optometry (SECO) 2021 Annual Meeting; April 28-May 2, 2021; Atlanta, GA. Course 118.