EFFICACY IN THE MANAGEMENT OF PAINFUL BLIND EYE

WHEN EYE PAIN AND INFLAMMATION ARE PRESENT

Abstract

Introducción: El ojo ciego doloroso es una afección compleja considerada la etapa final de diversas enfermedades oculares. Se caracteriza por un daño estructural y funcional irreversible en el ojo, generando dolor crónico y persistente que afecta significativamente la calidad de vida de los pacientes. Se han descrito diversos tratamientos para su manejo; sin embargo, no existe un consenso basado en la evidencia para decidir sobre el tratamiento quirúrgico temprano debido a sus implicaciones estéticas y psicosociales.

Objetivo: Determinar la eficacia de los principales tratamientos para el control del dolor ocular en pacientes con ojo ciego doloroso en el Departamento de Oftalmología del INRLGII.

Materiales y métodos: Estudio descriptivo retrospectivo que incluyó la revisión de 130 registros de SAIH con diagnóstico de ojo ciego doloroso, atendidos en el Servicio de Oftalmología del INRLGII durante un período de 14 años (2010-2024). Se excluyeron 28 registros por información incompleta. Se analizaron datos sociodemográficos, las principales causas de ojo ciego doloroso, el tipo e intensidad del dolor ocular y el tratamiento empleado. Se utilizaron estadísticas descriptivas y pruebas no paramétricas (Chi cuadrado, prueba Q de Crochran y prueba de Wilcoxon) según el tipo y la medición de las variables, con un nivel de significancia de α = 0,05.

Results: A sample of 102 patients was studied, 51 female and 51 male. The average age was 63 years. No differences were found regarding laterality. The main causes of painful blind eye were endophthalmitis in 45.09% (46 eyes) and neovascular glaucoma in 25.49% (26 eyes). Regarding the characteristics of the pain reported by the patients, dull pain was the most frequent in 44.11% (45 eyes) and stabbing in 43.13% (44 eyes). 100% (102 eyes) received first-line topical treatment (cycloplegics, steroids, and ocular hypotensives), of which 45.09% (46 eyes) reported pain relief; In 14.70% (15 eyes), alcoholic optic nerve neurolysis or cyclophotocoagulation were also performed due to persistent pain. Only 7.84% (8 eyes) had a good therapeutic response, and in 40.19% (41 eyes) that did not respond to previous treatments, evisceration was performed as a definitive treatment, with pain control in 88.23%. The choice of surgical treatment was significantly correlated with greater pain intensity. The duration of pain from onset to initiation of surgical treatment was 56 days. Persistent dull or stabbing pain was observed in 3.92% (4 eyes) after evisceration, but it disappeared over time.

Conclusions: First-line topical treatment alone or in combination with minimally invasive interventions relieved pain in half of cases, while evisceration controlled pain in almost all patients. Cosmetic rehabilitation and psychological management should be considered before and after surgical treatment to improve quality of life.

Keywords: painful blind eye, persistent eye pain, evisceration