Alkoholinjektion bei chronischem orbitalem Schmerz nach Enukleation – Falldarstellung und Literaturübersicht

Zusammenfassung

Es wird der Fall einer 54-jährigen Patientin dargestellt, bei der 10 Monate zuvor wegen eines blinden, schmerzhaften Auges eine Enukleation vorgenommen worden war und die jetzt unter heftigen unstillbaren Schmerzen litt. Nach einer Injektion von 1,5 ml 96 %igem Ethanol ist die Patientin seit 6 Monaten anhaltend nahezu beschwerdefrei. Orbitaler Schmerz nach Enukleation oder Eviszeration kann seine Ursache im Implantat selbst, in der Prothese, der Prothesenhöhle oder den Nasennebenhöhlen haben. Eine sorgfältige Anamnese und Untersuchung inklusive orbitaler Bildgebung sind notwendig, um die korrekte Differenzialdiagnose zu erhalten. Wenn eine Pathologie als Grundlage des Schmerzes ausgeschlossen erscheint, sollte auch an den häufig vorkommenden Phantomschmerz gedacht werden. Die Behandlung chronischer orbitaler Schmerzen findet nicht immer die gebührliche Würdigung. Die orbitale Alkoholinjektion hat in ausgewählten Einzelfällen aufgrund der guten Schmerzstillung und des niedrigen Risikoprofils immer noch ihre Daseinsberechtigung in der modernen Augenheilkunde.

Abstract

A case is presented of a 54-year old patient who had been treated 10 months previously with enucleation for a painful blind eye. This led to severe and chronic pain in the orbital region that did not respond to conventional pain management. However, a single 1.5 ml injection of 96 % ethanol led to almost complete resolution of pain for the follow-up period of 6 months. Orbital pain after enucleation or evisceration may originate from the implant itself, the prosthesis, the socket or the sinuses. Taking a careful medical history and an examination, including orbital scans, are necessary to decide on the correct differential diagnosis. If any pathology is excluded, one should keep in mind that phantom pain in the orbit seems common after removing an eye, more often when pain originating from the ball and/or headache was present before removal. The management of chronic pain in the orbital region has received little attention. Retrobulbar alcohol injection still has a place in modern ophthalmology, because it delivers effective pain relief in certain chronic conditions.

Schlüsselwörter

Orbita - Pathologie - plastische Chirurgie - Schmerz - Ethanol - Injektion

Key words

orbit - pathology - plastic surgery - pain - ethanol - injection

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