What about postop pain

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Most of the bad pain tends to occur right at the time of the laser, and then re solves once the treatment is over. However, sometimes the pain shows up later and can be quite severe, especially if the patient was blocked and you put in a lot of treatment. First of all, you do need to see the patient if there is increasing pain. As will be discussed in the next chapter, you need to make sure the cornea, and, in particular, the intraocular pressure are OK because these things can cause pain that needs to be treated with something other than "take two aspirin and call me in the morning."

Most of the time the eye itself will be doing well, but the person attached to the eye will be miserable. If you do a lot of laser at one session, you may want to give them a topical steroid and cycloplegics to head this off. You can also try oral pain medicine, although many diabetics are not allowed to have nonsteroid-als due to possible effects on kidney function. Diabetics can also get violently nauseated from narcotics due to GI motility problems combined with the tendency of eye pain to produce nausea. Sometimes simple things like a cool or warm compress can help, and on rare occasion the most merciful thing to do is to re-block the patient using a long-acting anesthetic. Usually, time is your best friend.

Some patients can even get so sick they throw themselves into diabetic ketoacidosis, so have a low threshold of referral to their internist, or even the emergency room, if they are telling you that they are having trouble keeping their food down or controlling their sugar. This type of severe problem seems more likely in younger patients with brittle disease.

In any event, if you do run into problems with post-op pain, be sure to note it in the chart; such patients benefit from doing the laser in smaller increments over longer intervals if at all possible.

References and Suggested Reading

1. Al-Hussainy S, Dodson PM, Gibson JM. Pain response and follow-up of patients undergoing panretinal laser photocoagulation with reduced exposure times. Eye 2008;22:96-9.

2. Simon MA, Cosgrove G, Zwillich CW, Chan ED. Respiratory arrest in the eye clinic. Chest 2001;119:1953-5.

Folk JC, Pulido JS. Laser photocoagulation of the retina and choroid. San Francisco: American Academy of Ophthalmology, 1997.

You Should Not Do Magic You Do Not Understand: Complications of Laser Treatment

Although each chapter covers some of the complications related to treating diabetic retinopathy, it is probably a good idea to gather all the potential complications together in one place so you can be reminded why you spent years learning how to do this.

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