Corneal Neuralgia after LASIK.

Area of Science:

• Ophthalmology
• Neurology
• Pain Management

Background:

• Dry eye syndrome is a common complication after laser-assisted in situ keratomileusis (LASIK).
• Refractory cases may indicate underlying neuropathic processes.
• Corneal neuralgia is a potential diagnosis for persistent post-LASIK dry eye.

Observation:

• Three male patients with refractory dry eye post-LASIK presented with pain and photophobia.
• Standard dry eye metrics and treatments were ineffective.
• In vivo confocal microscopy revealed abnormalities suggestive of neuropathic changes.

Findings:

• All patients showed improvement with multimodal treatment including autologous serum tears, PROSE treatment, and systemic agents.
• Symptoms resolved by a mean of 23 months post-LASIK.
• In vivo confocal microscopy supported a neuropathic basis for the symptoms.

Implications:

• Persistent dry eye post-LASIK may represent corneal neuralgia.
• In vivo confocal microscopy aids in diagnosing neuropathic corneal conditions.
• Early, multimodal treatment is crucial to prevent chronic pain.