1. 2017;20;429-436Opioids for Ocular Pain – A Narrative Review
   Narrative Review
   Vinicius BP Pereira, MD, Renato Garcia, MD, Andre AM Torricelli, MD, and Samir J. Bechara, MD.

BACKGROUND: Refractive surgery is a common procedure, but may be associated with severe post-operative pain.

OBJECTIVES: To describe studies addressing the use of opioids for control of pain after ocular surgery, with an emphasis on refractive surgery.

STUDY DESIGN: This is a narrative review of relevant articles on the physiology of corneal pain and the use of opioids for its treatment after surgery.

SETTING: Single tertiary center.

METHODS: A PubMed search was conducted for studies published from January 1985 to May 2015 on the physiopathology of corneal pain and opioid treatment of post-refractive surgical pain. Reviews, meta-analyses, and randomized clinical trials were included. Inclusion criteria focused on photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK).

RESULTS: Authors found 109 articles through the search strategies. A total of 75 articles were included based on the inclusion criteria.

DISCUSSION: Pain after ocular surgery is likely to be a multifactorial phenomenon. A combination of topical and systemic analgesics is used to treat post-operative pain after refractive surgery. Pain may be severe during the first 72 to 96 hours, depending on the surgical procedure. No studies were found that directly analyze the benefits of opioids after PRK, although they are routinely prescribed in some centers.

LIMITATIONS: This is a narrative review in contrast to a systematic review and did not include studies indexed in databases other than PubMed.

CONCLUSIONS: Although opioids are used for the short-term treatment of post-operative pain in refractive surgery, their benefits and risks should be properly evaluated in randomized clinical trials before their use can be safely advised.

KEY WORDS: Photorefractive keratectomy, in situ keratomileusis, pain, analgesia, opioid, codeine, review