By Dawnielle J. Kerner, MD
Neuropathic corneal pain is severe pain in the eye, head and face. The structures surrounding the eye are extremely sensitive to touch and light. This corneal neuralgia is a variation of reflex sympathetic dystrophy, which is often misdiagnosed. The symptoms often overlap with those of dry eye. However, the symptoms are usually more severe. If not treated in a timely manner, the pain may progress to the point where some patients may feel that the pain and disability disrupt their lives.
The symptoms of neurotrophic pain are often indistinguishable from those of dry eye in the early stages. Many patients will have eye pain, sensitivity to light, foreign body sensation, burning and dryness. However, their symptoms will not improve with dry eye therapy and may worsen. Patients may not have much dryness on an exam. The pain is often more severe and radiates to the head and the ear.
The exact cause of neuropathic corneal pain is not known. The etiology of neuropathic corneal pain appears to be a combination of corneal nerve injury and inflammation. The injured nerves do not heal properly, and the chronic low-grade inflammation causes a negative feedback loop of inappropriate pain signals to and from the brain. The damaged nerves can be seen on confocal microscopes. Confocal microscopes are often found at large academic research centers or large ophthalmic practices.
Inciting causes for neuropathic corneal pain can be anything that injures the corneal nerves, such as LASIK, cataract surgery, chronic contact lens wear, radiation therapy to the head or neck, chronic dry eye disease, toxicity from eye drop preservatives, ophthalmic shingles, trigeminal neuralgia and diabetes mellites.
As with other types of reflex sympathetic dystrophy, patients with some preexisting neurological and psychological syndromes seem more likely to develop neuropathic corneal pain. Associated conditions are anxiety, depression, chronic migraines and headaches, fibromyalgia and autoimmune diseases.
Treatment is aimed at regenerating the damaged nerves and reducing inflammation. The initial treatment includes lubricating eye drops and low-dose steroid drops. It can progress to amniotic membrane contact lenses, neurostimulation, systemic neuromodulation therapies, and topical recombinant corneal nerve growth factor. Step therapy and multiple therapies may be needed to fully treat the neuropathic pain since many patients are not diagnosed until late in the course of the disease. The condition responds better if it is treated sooner.
Dawnielle J. Kerner, MD, is a highly skilled, Board certified ophthalmologist with over 20 years of clinical experience. She has a special interest in treating patients with glaucoma; this includes patients 12 years of age and older with congenital glaucoma. She is currently accepting new patients at her office, The Ophthalmology Center in Virginia Beach. mytpmg.com/physician/dawnielle-kerner-md/
