title: Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of Ophthalmic Postherpetic Neuralgia: A Case Report.
abstract: Varicella zoster virus reactivation can cause permanent histological changes in the central and peripheral nervous system. Neural inflammatory changes or damage to the dorsal root ganglia sensory nerve fibers during reactivation can lead to postherpetic neuralgia (PHN). For PHN of the first division of the fifth cranial nerve (ophthalmic division of the trigeminal ganglion), there is evidence of inflammatory change in the ganglion and adjacent ocular neural structures. First division trigeminal nerve PHN can prove to be difficult and sometimes even impossible to manage despite the use of a wide range of conservative measures, including anticonvulsant and antidepressant medication. Steroids have been shown to play an important role by suppressing neural inflammatory processes. We therefore chose the trigeminal ganglion as an interventional target for an 88-year-old woman with severe ophthalmic division PHN after she failed to respond to conservative treatment.
  
  
  
  Under fluoroscopic guidance, a trigeminal ganglion nerve block was performed with lidocaine combined with dexamethasone. A retrobulbar block with lidocaine and triamcinolone settled residual oculodynia.
  
  
  
  At 1-year follow-up, the patient remained pain free and did not require analgesic medication.
  
  
  
  To our knowledge, this is the first reported case of ophthalmic division PHN successfully treated with a combination of trigeminal ganglion and retrobulbar nerve block using a local anesthetic agent and steroid for central and peripheral neural inflammatory processes.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Shenyang Medical College, Shenyang, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Physical and Rehabilitation Medicine, Shenyang Medical College, Shenyang, China.|Shenyang Dong-Ao Pain Management Clinic, Shenyang, China.
authors.forename: Zhongge
authors.initials: Z
authors.lastname: Ni
authors.affiliation: Perth Pain Management Centre, South Perth, Western Australia, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Finch
mesh_terms: D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D051474:Neuralgia, Postherpetic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D009882:Ophthalmic Nerve / Q000000981:diagnostic imaging / Q000187:drug effects*; D012668:Trigeminal Ganglion / Q000000981:diagnostic imaging / Q000187:drug effects*; D014277:Trigeminal Neuralgia / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D008012:Lidocaine
keywords: ophthalmic postherpetic neuralgia; trigeminal and retrobulbar injection steroid