Neuropathic pain in the eye after Lasik

What are the symptoms?

Neuropathic pain in the eye after Lasik is characeterised by increased sensivity to cold, heat, touch and wind. Symptoms experience include dryness of eyes, burning sensation, grittiness and increased sensitivity to bright lights.

When is the pain in my eye more likely to be neuropathic pain?

Pain in the eye in the first 3 months is acute pain and can be the body’s normal response to surgery and tissue damage. Pain after 3 months is usually neuropathic, the result of irritated or damaged nerves.

Why does it occur?

It is thought to be because of inflammation, and involve the damage to the small nerve fibres in the cornea from trauma or from chemicals. This can be due to surgery, air pollution, and even dry air. The nerve endings become irritated and sends abnormal signals even when there are no triggers. When damaged nerves heal, sometimes they grow aberrantly and connect with other nerves in what is known as neuroplasticity. This results in normal sensations such as wind and temperature changes being misinterpreted as pain. Neuropathic pain is out of proportion to the source of the irritation, and in many cases can occur when there is nothing wrong at all!

neuropathic pain of the eye after Lasik and other procedures can be treated with topical eyedrops such as corticosteroids or immunosuppressants, or with oral medications including gabapentin, pregabalin or antidepressants. Nerve blocks and pulse radiofrequency targeting the stellate ganglion, sphenopalatine ganglion can be tried, as well as blocks around the eye.

Who is at risk of neuropathic pain of the eye?

Women are at risk and have more severe symptoms. There is a genetic component as well with people with a COMT gene variation being more susceptible. Older people as well as pregnant women are less at risk.

How to treat neuropathic pain in the eye after Lasik?

  • Topical eye drops reduce sensitivity in the eye. Examples include:
    • Lubricants
    • Corticosteroids
    • Immunosuppressants
    • Regenerative therapy
  • Medications to target the nerves involved in the pain pathway
    • Gabapentin and pregabalin
    • Antidepressants such as tricyclics and selective norepinephrine reuptake inhibitors
  • Pain procedures
  • Managing impact of neuropathic pain of the eye