Referred Ocular Pain Relieved by Suboccipital Injection


  • Presented at the meeting of the North American Neuro-Ophthalmology Society, Durango, Colorado, February 28, 1994.

Dr. Gregory S. Kosmorsky, Division of Ophthalmology, A31, Cleveland Clinic Foundation, Cleveland, OH 44195.


Pain originating from ophthalmic disease has been well documented. A series of patients presenting with eye or peri-orbital pain attributed to cervical region dysfunction were diagnosed and treated with injections of subcutaneous lidocaine followed by triamcinolone acetonide. Twelve patients, 11 women and I man, ranging in age from 20 to 82 years had an evaluation including a complete eye examination, and laboratory tests and neuroimaging as dictated by the history to exclude structural abnormalities or systemic disease. All patients had marked focal suboccipital tenderness ipsilateral to the side of their headache and eye pain. A subcutaneous injection with 2% lidocaine followed by triamcinolone acetonide 40 mg was administered directly to the site of focal tenderness. After injection, five patients described total relief of pain, five patients described some degree of pain relief, and two patients had no relief of headache. Duration of pain relief ranged from several hours to 3 months. Patients may present with periorbital or eye pain as a result of disease affecting the cervical sensory roots with subsequent stimulation of the trigeminal apparatus. Subcutaneous injection of lidocaine and triamcinolone acetonide may be of help in the diagnosis of these patients and provide temporary relief.