Topical analgesics for acute corneal pain: current options and emerging therapeutics.

Acute corneal pain is a common complaint that causes significant distress to patients and continues to challenge therapeutic avenues for pain management. Current topical treatment options have marked limitations in terms of both efficacy and safety, thus often prompting the adjunctive use of systemic analgesics, including opioids. In general, there have not been extensive advancements in pharmacologic options for the management of corneal pain over the past several decades. Despite this, multiple promising therapeutic avenues exist which hold the potential to transform the ocular pain landscape, including druggable targets within the endocannabinoid system. This review will summarize the current evidence base for topical nonsteroidal anti-inflammatory drugs, anticholinergic agents, and anesthetics before focusing on several potential avenues in the setting of acute corneal pain management, including autologous tear serum, topical opioids and endocannabinoid system modulators.

Efficacy and safety of pain relief medications after photorefractive keratectomy: review of prospective randomized trials.

UNLABELLED: The objective of this review was to provide a comprehensive overview and comparison of results from all prospective randomized trials published to date of medications used to treat pain after photorefrative keratectomy (PRK). A PubMed database search revealed 23 prospective and randomized studies. They included the following classes of medications: nonsteroidal antiimflammatory drugs (NSAIDs), anesthetics, opiates, acetaminophen, gabapentin, and pregabalin. The studies found that although the efficacy of drugs tended to be similar, tetracaine 1% and nepafenac 0.1% tended to have the most analgesic effect. Delayed corneal reepithelialization was a common side effect of both topical anesthetics and topical NSAIDs. Tetracaine 1% resulted in the most significant delay in reepithelialization when tested against placebo control compared with other topical medications tested against placebo. Concomitant use of topical NSAIDs and topical anesthetics, especially tetracaine, may have to be avoided to minimize the risk for delayed corneal healing. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Effect of topical 0.5% morphine on postoperative pain after photorefractive keratectomy.

PURPOSE: To investigate safety and efficacy of 0.5% morphine drops for pain control after photorefractive keratectomy (PRK). METHODS: In a double-blind prospective study, 40 patients were randomized to either 0.5% morphine drops (n=20) or vehicle control (n=20). Treatment occurred every 2 hours following PRK on the day of the procedure, then four times daily on postoperative days 1 through 3. Patients completed pain assessment questionnaires (visual descriptor, numerical rating, visual analog scales, and oral analgesic consumption) every 2 hours while awake during the treatment period. Daily average and maximum scores were compared between the two groups. Patients were examined daily for 4 days after PRK, weekly for 4 weeks, then monthly for 3 months. Epithelial healing, corneal haze, and refractive outcomes were compared. RESULTS: Both average and maximum pain scores were lower in the morphine group than in the vehicle control group on all scales and during all 4 days after PRK. Statistical significance (P<.05) was reached on numeric rating scale on procedure day and on postoperative day 1. The difference between the groups on the visual analog scale was statistically significant on procedure day, and on postoperative days 1 and 2. Oral analgesic consumption was higher in the vehicle control group on postoperative day 2. No difference between groups was noted in epithelial healing or refractive outcomes. Stromal haze scores were lower in the morphine group, but the difference was not statistically significant. CONCLUSIONS: Topical 0.5% morphine may be an effective and safe method of pain control after PRK.

Epithelial removal and phototherapeutic keratectomy for residual refractive error following LASIK in eyes with corneal epithelial basement membrane degeneration.

PURPOSE: To retrospectively evaluate the efficacy of epithelial removal followed by phototherapeutic keratectomy (PTK) for reducing residual refractive error in eyes with corneal epithelial basement membrane degeneration after LASIK. METHODS: Eight eyes of four patients with residual refractive error and signs of epithelial basement membrane degeneration after LASIK were followed until their refractive error stabilized. Epithelium was debrided and PTK performed. Refractive error and visual acuity outcomes were analyzed. RESULTS: In the six eyes that underwent LASIK for myopic astigmatism, mean spherical equivalent refraction after LASIK was -1.75 +/- 0.62 diopters (D) and mean astigmatism was +0.75 +/- 0.59 D. After PTK, mean spherical equivalent refraction was -0.33 +/- 0.35 D and mean astigmatism was +0.50 +/- 0.27 D. Mean logMAR uncorrected visual acuity (UCVA) improved from 0.39 +/- 0.31 before PTK to 0.03 +/- 0.05 after PTK. Mean Snellen UCVA improved from 20/50 before PTK to 20/20 after PTK. In two eyes that underwent LASIK for hyperopic astigmatism, mean spherical equivalent refraction after LASIK was +4.38 +/- 0.35 D and mean astigmatism was +3.25 D. After PTK, mean spherical equivalent refraction decreased to +1.56 +/- 0.44 D and mean astigmatism decreased to +2.13 +/- 0.53 D. Mean logMAR UCVA improved from 0.24 to 0.14. Mean Snellen UCVA improved from 20/35 to 20/27. CONCLUSIONS: In eyes with epithelial basement membrane degeneration and refractive error after LASIK, epithelial removal followed by PTK may reduce refractive error, both myopic and hyperopic, bringing it close to emmetropia and avoiding the need for traditional stromal enhancement.