For glaucoma patients who have lost useful vision, the focus of medical care shifts to palliation. Intraocular pressure still needs to be controlled at a level that is low enough to prevent pain.
It is also important to manage corneal edema to prevent the development of painful bullae. That may include the use of hypertonic salt solution, bandage soft contact lens wear, keratoplasty, or corneal cautery.
Interventions that can be used for pain control include atropine, topical corticosteroids, topical NSAIDs, retrobulbar chlorpromazine, or alcohol–even evisceration or enucleation.
“Some of my happiest patients are the ones who finally agree to evisceration or enucleation after enduring pain for some time in a blind eye,” Dr. Stamper said.