title: Lacrimal Nerve Blocks for Three New Cases of Lacrimal Neuralgia.
abstract: OBJECTIVE
  Our aim was to report three new cases of lacrimal neuralgia and their response to superficial nerve blocks.
  
  
  BACKGROUND
  Lacrimal neuralgia has been recently described as a pain in the territory supplied by the lacrimal nerve, at the lateral upper eyelid and/or the adjacent area of the temple. The pain is typically accompanied by tenderness on palpation of the lacrimal nerve at the superoexternal angle of the orbit.
  
  
  METHODS
  Between January 2015 and June 2016, we prospective identified three cases of lacrimal neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anesthetic blocks were performed in all cases by inserting a 30-G needle on the emergence of the nerve and injecting 0.5 cc of bupivacaine 0.5% subcutaneously.
  
  
  RESULTS
  Three women aged 44, 49, and 51 presented with pain in the territory supplied by the lacrimal nerve. Two of them localized their pain in a small area of the right temple, while the remaining patient had pain in the right upper lateral eyelid and a small area of the lower lateral eyelid. The pain was continuous in two patients and episodic with attacks lasting 48 hours in one patient. All patients had tenderness on palpation of the lacrimal nerve. Anesthetic blocks confirmed the diagnosis of lacrimal neuralgia and provided the patients with long-lasting pain relief.
  
  
  CONCLUSIONS
  Lacrimal neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Superficial nerve blocks may assist clinicians in the diagnosis and may also be a therapeutic option.
authors.affiliation: Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.|Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: María-Luz
authors.initials: ML
authors.lastname: Cuadrado
authors.affiliation: Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Gutiérrez-Viedma
authors.affiliation: Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Silva-Hernández
authors.affiliation: Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Orviz
authors.affiliation: Headache Unit, Department of Neurology, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: García-Moreno
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007765:Lacrimal Apparatus; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D009437:Neuralgia / Q000628:therapy*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: cranial neuralgia; lacrimal nerve; lacrimal neuralgia; nerve block; terminal branch neuralgia; trigeminal nerve