Children's collagen cross-linking aftercare

Pain relief options

There are three pain relief options:

1. Proxymetacaine: a local anaesthetic drop applied directly on the eye. It starts working in less than a minute and can last for 15 minutes or longer. This should be used sparingly.
2. Paracetamol and ibuprofen: these come as tablets or syrup and you can give these to your child at the same time. They should be given regularly for a minimum of 2 days.
3. Oral morphine (Oramorph®): This is a very strong pain killer that comes as a liquid solution. You can give this if you have already given paracetamol and ibuprofen and your child is still in pain.

Correct doses of pain relief drugs

The correct dose depends on your child’s weight. It is very important that you follow the prescription regarding the amount that you can give, as well as the correct frequency.

Please speak to your nurse or doctor before you leave the hospital if you are unsure how much or how often you can give pain relief to your child.

What you need to know about oral morphine (Oramorph®)

Your doctor has prescribed your child oral morphine to take home if they need it for pain relief. It is very important that you give this medication as instructed by your doctor, and do not go over the maximum dose or frequency. You should give this medication if your child is experiencing pain, despite giving them paracetamol and ibuprofen first.

If you think you may have given your child too much, you should speak to your doctor immediately.

Oral morphine is very effective in reducing your child’s pain, however like all medication it can have side effects like the ones listed below:

• itching
• nausea and vomiting
• constipation: to combat this, ensure your child is well hydrated, and eating fruits and foods rich in fibre.
• urinary retention (not being able to wee): contact your doctor
• dizziness, sweating, red skin.

If any of the above are problematic, please call the ward for advice on 020 7566 2595.

Because of the small number of doses that have been prescribed, it is not possible to develop long term side effects like addiction and tolerance to morphine.

Some children may not be suitable to have oral morphine, for example those already taking sedative medications or experiencing obstructive sleep apnoea. This is because they may be at higher risk of complications. Your doctor will not prescribe it in that case, and will discuss alternatives.

Concerning signs for immediate medical attention

Provided that the safe dose and frequency of giving the medication is followed correctly, oral morphine is safe for children. You should seek immediate medical attention by calling an ambulance if:

• your child is having breathing problems, slow breathing or has stopped breathing
• your child is very drowsy or unable to be woken up.

Instructions on how to handle oral morphine (oramorph®)

Please keep oral morphine out of your child’s reach and sight. It should be stored in a cupboard away from sunlight.

Once you are happy that your child’s pain has reduced following their surgery (usually within 2-3 days), you should take any remaining oral morphine to your local pharmacy where it can be disposed of safely. Do not store it or give it to anyone else.

Summary table of eye drops and oral medication

Day of surgery (Day 0) to Day 2:  Eye drops

Day of surgery (Day 0) to Day 2:  Oral medication

 Day 3 to Day 7:  Eye drops

 Day 8 to Day 14:  Eye drops

 Day 15 to Day 28:  Eye drops

Review date: July 2025