Efficacy and safety of patching vs bandage lens on postoperative pain following pterygium surgery

SIR, Pterygium surgery is typically performed in an outpatient setting with subconjunctival anesthesia.1 Owing to the short duration of action of local anesthesia, patients may experience

considerable pain and discomfort following surgery once anesthesia has worn off. Wishaw _et al_2 showed that clinically significant postoperative pain (conjunctival and corneal origin) is

reportedly experienced in 60% of patients undergoing pterygium surgery. The purpose of this prospective randomized study was to compare the postoperative pain, and symptoms of photophobia,

epiphora, and foreign body sensation, with overnight patching _vs_ placement of a bandage lens for the management of postoperative pain following pterygium surgery. RESULTS Of 30 eyes in

each group, 15/30 in the patching group and 17/30 in the bandage lens group were male. All but one case in each group had nasal pterygia. The mean age of patients was 50.1±10.6 years in the

patching group and 49.0±16.9 years in the bandage lens group. No statistically significant differences existed between the two groups with respect to age, laterality, pterygium location,

gender, size of pterygium, size of conjunctival autograft required, or preoperative visual acuity (Table 1). COMMENT Figure 1 summarizes the results of the primary and secondary end points

of the study. There was no statistically significant difference in VAS pain score or amount of pain medication taken between groups during the first week. Significantly more eyes were

reported to be photophobic on POD 0 in the bandage lens group (_P_=0.01; odds ratio=4.0). Using linear logistic regression analysis, VAS pain score predicted the amount of pain medication

taken on the same day (_P_<0.0001; no significant difference between groups). On POD 0 only, VAS pain score was statistically significantly related to the graft area required (_P_=0.023).

Age was noted to be inversely correlated to the amount of pain medication taken; for every additional year of age, a given patient would have taken 0.13 less tablets (_P_=0.0009). None of

the clinical symptoms (photophobia, epiphora, and foreign body sensation) were predicted by any of the baseline characteristic of the groups. Interestingly, postoperative pain and

requirement for pain medication (acetaminophen with codeine tablets) was similar after POD 1, when the patch was removed. The bandage lens during the first postoperative week did not appear

to improve comfort. These results suggest that both modalities help in reducing the postoperative pain following pterygium excision, although overnight patching may provide further relief

from the symptoms of photophobia. Either overnight patching or the placement of a bandage contact lens is safe and effective in the management of postoperative pain following excision of

primary pterygia with CAU. In cases where overnight patching would interfere with the visual needs of the patient, the placement of a bandage lens is preferable. REFERENCES * Smith RB,

Everett WG . Physiology and pharmacology of local anesthetic agents. _Int Ophthalmol Clin_ 1973; 13 (2): 35–60. CAS  PubMed  Google Scholar  * Wishaw K, Billington D, O'Brien D, Davies

P . The use of orbital morphine for postoperative analgesia in pterygium surgery. _Anaesth Intensive Care_ 2000; 28 (1): 43–45. Article  CAS  Google Scholar  Download references AUTHOR

INFORMATION AUTHORS AND AFFILIATIONS * Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada S N Yeung, A Lichtinger, P Kim, U Elbaz, J Y F

Ku, M D Amiran & A R Slomovic * Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada S N Yeung * Department of Ophthalmology, McMaster University, Hamilton,

ON, Canada J C Teichman Authors * S N Yeung View author publications You can also search for this author inPubMed Google Scholar * A Lichtinger View author publications You can also search

for this author inPubMed Google Scholar * P Kim View author publications You can also search for this author inPubMed Google Scholar * U Elbaz View author publications You can also search

for this author inPubMed Google Scholar * J Y F Ku View author publications You can also search for this author inPubMed Google Scholar * J C Teichman View author publications You can also

search for this author inPubMed Google Scholar * M D Amiran View author publications You can also search for this author inPubMed Google Scholar * A R Slomovic View author publications You

can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to S N Yeung. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no conflict of interest.

RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Yeung, S., Lichtinger, A., Kim, P. _et al._ Efficacy and safety of patching _vs_ bandage lens on

postoperative pain following pterygium surgery. _Eye_ 29, 295–296 (2015). https://doi.org/10.1038/eye.2014.286 Download citation * Published: 05 December 2014 * Issue Date: February 2015 *

DOI: https://doi.org/10.1038/eye.2014.286 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not

currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative