Cryoablation of the Supratrochlear and Supraorbital Nerves for Herpes Zoster Ophthalmicus

Abstract Herpes zoster ophthalmicus (HZO) frequently results in severe neuropathic pain that is often refractory to conventional pharmacological management. Peripheral nerve cryoablation represents an emerging minimally invasive intervention for targeted pain relief in selected patients. A 73-year-old male presented with severe HZO-related pain involving the supraorbital, supratrochlear, and infraorbital nerve distributions, refractory to duloxetine and pregabalin therapy. Under ultrasound guidance, percutaneous cryoablation was performed targeting the supraorbital, supratrochlear, and infraorbital nerves using a cryoprobe at − 78°C with single freeze–thaw cycles lasting 2 min 45 s per nerve. The patient was monitored for immediate complications, including chemosis, ptosis, acute pain exacerbation, and localized inflammation. The procedure was technically successful with immediate pain relief and no acute complications. The technique demonstrated reproducibility and safety in this challenging clinical scenario. Ultrasound-guided cryoablation of trigeminal nerve branches represents a feasible and potentially effective intervention for HZO-related pain refractory to medical management, warranting consideration as an early interventional option in selected patients.