Eye pain

[DOCTORSAIB]

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Hey guys,

Ophtho resident here. I was observing some LASIK surgery yesterday and the attending recommended Lyrica or Neurontin for his refractive surgery patients for a few days post-op. He also prescribes it to patients with intense pain from corneal abrasions.

I found a couple of papers on pubmed regarding neurontin for refractive patients and one case study for treatment of painful blind eye from advanced glaucoma (an optic neuropathy of sorts).

Just wondering if you guys have ever treated patients with chronic eye pain and if you think Lyrica or Neurontin is a good alternative to opiods. This is all news to me.

 

[lobelsteve]

Chest Pain: ER.
Eye Pain: Ophtho.

If ophtho clears them then neuropathic agents are reasonable if the pain is neuropathic.

Stick a needle in my eye- no way.

 

[PMR 4 MSK]

Low-risk medicine with mostly nuisance side effects, so I can see it.

I don't see it needed routinely for LASIK.

 

[Ligament]

I see no reason not to trial Lyrica or Neurontin for eye pain. They are both very, very safe medications, much safer than almost anything else. If you want to trial it on your patients would suggest Lyrica 75mg PO Q12hrs or Neurontin 300-600 mg PO Q8hrs. The only eye pain patients I have treated where post enucleation patients which required very strong medications.

 

[DOCTORSAIB]

Thanks guys for your input. 👍

 

[Tenesma]

just remember that lyrica can cause fuzzy vision in some.... so if they just had refractive surgery, and they complain of fuzzy vision who are you going to blame? the med or the procedure? in some patients it can take a week or so for the fuzziness from lyrica to dissipate

 

[DOCTORSAIB]

just remember that lyrica can cause fuzzy vision in some.... so if they just had refractive surgery, and they complain of fuzzy vision who are you going to blame? the med or the procedure? in some patients it can take a week or so for the fuzziness from lyrica to dissipate

Why would Lyrica cause fuzzy vision?

Or is this one of those side effects that b/c 1 out 1,000 patients in the original Lyrica trial said "yes" to and now it's legally required to be printed on every drugsheet? haha.

 

[Tenesma]

it probably causes blurry vision for the same reason it causes xerostomia, urinary retention, confusion in some --- inhibition of norepinephrine release (?)

and i believe the reported incidence of blurry vision is dose dependent but varies from 3-6% compared to less than 2% for placebo....

i have a few who discontinue lyrica every few months because of side-effects including blurry vision, weight gain, etc...

 

[Ligament]

Just to temper Tenesma's comments, yes people do get these side effects but it is really quite rare and usually mild, ESPECIALLY compared to side effects from opioids.

 

[Tenesma]

absolutely agree w/ ligament...

however, after refractive surgery, i would be a bit leary of using any medication that may contribute to blurry vision as that would affect your post procedure eval...

 

[Ligament]

absolutely agree w/ ligament...

however, after refractive surgery, i would be a bit leary of using any medication that may contribute to blurry vision as that would affect your post procedure eval...

Concur with Tenesma's concern 🙂