Ocular Pain Management in the Opioid Epidemic with Blair Lonsberry, OD

At the 2025 American Optometric Association Conference in Minneapolis, MN, Blair Lonsberry, OD, Pacific Eyeclinic Portland, presented his lecture on the opioid epidemic and its presence in postoperative optometric pain management.1

Given the prevalence of opioid abuse in the US, various studies have investigated alternative treatment methods to avoid prescribing these painkillers. Although surgeons write only 10% of opioid prescriptions annually, with optometrists and ophthalmologists writing a fraction of this amount, all physicians have been encouraged to be cognizant of ways to decrease unnecessary prescriptions.2

Options such as peri-operative intravenous or oral nonopioid analgesics have been floated as ways to reduce postoperative opioid use after ophthalmic surgery, and recent literature has shifted focus towards more stringent guidelines to manage postoperative pain.2

Sitting down with HCPLive before his presentation, Lonsberry discussed alternate pain management methods, which have proven equivalent to opioids in certain doses.

“There have been several studies to show that if you use something like 1000 mg of acetaminophen plus 400 mg of ibuprofen at one time, it’s equal to 5 mg of hydrocodone, and at that point you’re not playing into the opioid epidemic,” Lonsberry told HCPLive. “I think there are other ways to manage pain; alternation of things like acetaminophen and ibuprofen every couple of hours can also help in that regard.”

Lonsberry also acknowledged that certain levels of pain force clinicians to offer opioids. He encouraged a responsible approach to these drugs, suggesting the lowest possible dose to overcome the initial pain threshold.

“Sometimes you do have to go into the opioids; if a patient’s pain is 9 or 10 out of 10, there’s not much else that’s going to take care of that,” Lonsberry said. “But we can do it responsibly by giving them 1 or 2 to get them over that pain threshold and then do alternations of other medications that I think are beneficial for patients, rather than having to push into using opioids all the time.”

Lonsberry advised clinicians considering opioids to utilize drug monitoring programs to ensure patients are not already taking opioids. Additionally, he noted the importance of checking for alternate names, as these are commonly used to receive multiple opioid prescriptions at once.

“If you’re going to prescribe an opioid, you have to go to a drug monitoring program, and at that point, once you sign into that program, you’ll be able to pull the patient up, make sure that they have not been prescribed the opioids from someone else,” Lonsberry said. “Tip on that one: you need to make sure you’re looking for their nicknames, too.”

Another critical concern is medications that may be fatal in combination with opioids. Lonsberry pointed out sedatives, such as benzodiazepines.

“Those in combination with opioids tend to be pretty deadly. Benzodiazepines are sedative medications; they make patients go to sleep. And once they go to sleep, the opioid kicks in and shuts down their breathing centers,” Lonsberry said. “That’s how a lot of deaths happen; they combine them not just with the opioid but with another medication that is sedative.”

Ultimately, Lonsberry recommended clinicians make themselves aware of alternative pain management strategies. Given the difficulty of gauging someone’s subjective pain, Lonsberry suggests clinicians need a better understanding of ocular pain management.

“I think we just have to be aware of what’s out there, pain management-wise,” Lonsberry said. “When patients are in pain, they want their pain managed now, and they want it managed over a 24-hour basis. They don’t want to have to wait for that. But our big concern is that, for patients coming in, my 5 might be their 10. It’s hard to gauge where their pain level is and to make sure we don’t automatically jump to something that we know is going to take care of their pain when we can try to figure out other ways to do that.”

References

1. Lonsberry B. Pain Management in Optometric Practice in the Era of an Opioid Epidemic. Presented at the 2025 American Optometric Association Conference in Minneapolis, MN, June 25-28, 2025.

2. Starr MR, Patel LG, Ammar M, Yonekawa Y. Opioids and ophthalmology: review of the current literature. Curr Opin Ophthalmol. 2021;32(3):209-213. doi:10.1097/ICU.0000000000000753