• What is causing my eye pain?


    Question:

    I've had severe eye pain in and around my left eye for over a year now. I'm about to see a second neurologist to see what diagnosis and treatment I should pursue. Here's what I know: I have dry eye syndrome but I do not have Sjogren’s. The eye pain seems triggered by dry or poor tears. I tried scleral lens but they trigger pain in my eye. I have four punctual plugs and use oil-based drops and ointment in my eyes at night. Do you feel the trigeminal nerve is affected? Do you feel a cornea transplant is an option?


    Answer:

    Some patients who are diagnosed with dry eye syndrome but not helped by traditional dry eye remedies may have a separate clinical problem known as corneal nerve-related, or neuropathic, pain. The condition is thought to be due to over-sensitization of pain receptors on the corneal surface. Symptoms are fairly typical for dry eye patients: burning, foreign body sensation, tearing, worse in windy environments; but they usually exceed what would be predicted by the findings on the exam. In addition, dry eye treatments such as artificial tears, plugs, Restasis, and scleral lenses have minimal benefit and sometimes make symptoms worse. Various remedies such as serum tears and neuropathic drugs like gabapentin and pregabalin, tricyclic anti-depressants, and acupuncture have been tried with varying levels of success. Corneal transplant is not a recommended treatment. The disease process and further treatments for neuropathic corneal pain is currently being researched by the National Institute of Health (NIH).


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