Neuropathic Corneal Pain Following LASIK Surgery: A Retrospective Case Series

Abstract

Introduction: Transient dry eye symptoms have been reported following laser in situ keratomileusis (LASIK). Very rarely, patients may present with debilitating symptoms of dry eye syndrome (DES) with limited or no evidence of ocular surface disease. These patients are diagnosed with a form of DES known as neuropathic corneal pain (NCP). Patients and Methods: This study is a retrospective medical record review of a case series of 18 patients who developed NCP post-LASIK over the years 1996-2021. All patients who developed severe ocular pain following LASIK consistent with NCP were included. Patients with severe ocular pain who had evidence of severe ocular surface disease or other ophthalmic etiology to explain their debilitating symptoms were not included. Results: The average age of patients in our study was 39.5 years. The majority of our patients were female (72.2%) and of Caucasian ancestry (83.3%). The average onset of symptoms was 9.6 months post-LASIK. Patients had past medical histories significant for neuropsychiatric conditions (50%), functional pain syndromes (22.2%), autoimmune diseases (33.3%), and hypothyroidism (27.8%), and the occurrence of these was higher than the national prevalence of these diseases. Symptoms were consistent with the severity and characteristics defining NCP. Treatment was multimodal, involved topical and systemic therapies, and was unique to each patient. Overall, the majority of patients had clinical improvement in symptoms following treatment with regular follow-up. Conclusion: Although rare, the 26-year prevalence of NCP post-LASIK in our study was roughly 1 in 900 cases. The mean time to onset after surgery was delayed at 9.6 months. Certain risk factors such as neuropsychiatric conditions, history of functional pain syndromes, history of autoimmune conditions, and hypothyroidism may predispose patients to the development of this condition. Patients benefited from proper

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Corneal opacities after small-incision lenticule extraction

“…Given that the Schirmer test is negative and that there is no evidence of ocular surface inflammation, a neurogenic etiology could account for the patient's symptoms. This may be a case of photoallodynia, which has been described in the literature as an ocular neuropathic pain syndrome 3 . In vivo confocal microscopy to evaluate the corneal nerves could help with this diagnosis.…”

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