We appreciate Dr Jordan's comments on our technique for controlling pain after orbital implant surgery. We have found throughout the years that some patients with hydroxyapatite orbital implants had severe pain following surgery, which was uncontrolled by the use of narcotics. The placement of an orbital catheter alleviated this problem of severe pain in many patients. We agree that a control group without catheters would have been beneficial. In our experience, patients receiving secondary implants have the most severe pain, probably owing to more extraocular muscle manipulation and orbital dissection. We have not found this to be as much of a problem with evisceration, possibility due to our technique. During evisceration, we remove a posterior scleral button containing the optic nerve and posterior ciliary nerves. This scleral button is cleaned of any uveal tissue and then placed anteriorly to the orbital implant. This serves 2 purposes: (1) to remove the sensory nerves to the eye and (2) to act as a reinforcing graft anteriorly.
Fezza J, Wesley RE, Klippenstein KA. Pain Control After Orbital Implant Surgery. Arch Ophthalmol. 2000;118(9):1306. doi: