Topical sevoflurane as an off-label analgesic for refractory painful blind eye. A proof-of-concept case series

There are few topical analgesic alternatives to treat refractory painful blind eye. We present a case series treated with topical sevoflurane. After approval from our Institutional Review Board, clinical and pharmacological information was collected from the charts of all our 11 patients with refractory painful blind eye treated with sevoflurane. The first in-hospital application of sevoflurane (dose < 0.5 mL) caused a rapid and intense analgesic effect in 10 patients, who were given a bottle of sevoflurane-filled eye drops to self-administer. Four patients discontinued treatment weeks later due to lack of effectiveness or rebound pain. Pain is still successfully controlled in the remaining six patients after several months. Well-tolerated itching was the most frequent unwanted effect (three cases). Topical ocular sevoflurane emerges as an easy to apply alternative for refractory painful blind eye, warranting further investigation to better depict its clinical profile.