Ocular Neuropathy

[david2404]

Hi,

Has anyone has first hand experience with the topical lacosamide that Dr. Rosenthal talks of in the following article?? I've pasted an extract below.

http://www.aao.org/publications/eyen...ea_FF_copy.pdf

Dr. Rosenthal believes the persistence of pain in the presence of a liquid bandage suggests that dysfunctional pain-generating sites are discharging spontaneously. In these cases, treatment must directly target the dysfunctional corneal nerve terminals and ectopic firing sites.In the past he (Dr. Rosenthal) has had success treating these patients with dilute, sub-hypoesthetic concentrations of local anesthetics in the fluid reservoir of the scleral lens. But more recently Dr. Rosenthal has used the new antiepileptic drug lacosamide. It has the ability, he said, to modulate overactive pain firing sites even though it has no anesthetic properties, adding credence to the notion that the pain is neuropathic. Dr. Rosenthal acquires lacosamide as a topical preparation compounded by Leiter’s Pharmacy

[Rebecca Petris]

No firsthand, just secondhand... I know several people who have used lacosamide with PROSE. I can't yet say whether any conclusive results. One has herpes Zoster and gets some benefit from it but again nothing conclusive yet. Hopefully some current users will respond as well.

[Reggie]

Wow, I haven't been on this site in a long time but I'm back looking to see if anything new out there can help us out. I was a part of Dr Rosenthal's neurpathic pain study a few years back and the drugs that were inserted in my lens didn't help me at all. I don't remember each of their names, but I was on 2 or 3 different meds by the time I was finishes. Still using the PROSE and it's the only thing that has made DES pretty tolerable (using PROSE since 06, severe dry eye since 2000).

[grandmamac]

Out of desperation I am looking into neuropathic pain meds. Has anybody tried gabapentin (neurontin) with any success managing dry eye pain? What else do people use to help with pain?
Thanks

[abbygirl]

Yes, out of desperation I have taken gabapentin along with Excedrin and it did help with the pain. I saw a Neurologist because I am experiencing horrible deep pain behind my eyeball that almost feels like a migraine behind my eye (but it isn't). The pain becomes unbearable so I have been experimenting with pain meds. My doctor said I could take up to 600 mgs a day but I am afraid to...I have taken 200mg. at a time and that seems to help.

[buntbean]

I take 1200mg of gabapentin 3X/day. I was also put on cymbalta 60mg at night and tramadol. I was put on all of them at the same time so it's hard to say what works and what doesn't work. They all do help with nerve pain though. I also take clonazepam when the pain gets unbearable. They say that's good for nerve pain as well.

I found this group online that related to the eye pain we describe
http://www.livingwithtn.org/group/eye-pain-and-tn-atn

[Ahmed]

Yes, out of desperation I have taken gabapentin along with Excedrin and it did help with the pain. I saw a Neurologist because I am experiencing horrible deep pain behind my eyeball that almost feels like a migraine behind my eye (but it isn't). The pain becomes unbearable so I have been experimenting with pain meds. My doctor said I could take up to 600 mgs a day but I am afraid to...I have taken 200mg. at a time and that seems to help.

Have you had a check though? Do you know why the eye is painful?

[littlemermaid]

Hi Ahmed, Good to see you thinking about this. If you click on the name you can then click on View Forum Posts to view the history quickly and think about aetiology and what might help, Abbygirl has a Hashimoto's thyroiditis diagnosis. Good luck

[abbygirl]

Ahmed,
Thank-you for taking an interest in my eye pain. I have yet to come up with a reason for this intense back of the eyeball eye pain. I have had CAT scans and MRI 's and all is normal except for the fact that I have unusually large eyeballs which I was born with. I also had a confocal microscope test which revealed nothing that would explain the pain. I see a corneal specialist at Baylor in Houston and he is stumped. I will be trying the PROSE lenses but am worried they may not work against this particular pain. I should get relief from the dry eye pain (I hope). I am starting to research Lupus...anyone with info on eye pain and Lupus?? Autoimmune diseases run in pairs and I have Hashimotos so this makes me wonder..

[Hopeful2]

Hi abbygirl,

Is it at all possible that the eye pain you experience at the back of your eye is eye strain related and may be due to spasm of the muscle there? I have had pain at the tops of my eyes which seems to be related to tension. I have tried exercises to release the tension and they seem to be helping.

If you have a thyroid disorder, could the eye pain be related to possible bulging of eyes?
Best wishes for relief!

[Ahmed]

Ahmed,
Thank-you for taking an interest in my eye pain. I have yet to come up with a reason for this intense back of the eyeball eye pain. I have had CAT scans and MRI 's and all is normal except for the fact that I have unusually large eyeballs which I was born with. I also had a confocal microscope test which revealed nothing that would explain the pain. I see a corneal specialist at Baylor in Houston and he is stumped. I will be trying the PROSE lenses but am worried they may not work against this particular pain. I should get relief from the dry eye pain (I hope). I am starting to research Lupus...anyone with info on eye pain and Lupus?? Autoimmune diseases run in pairs and I have Hashimotos so this makes me wonder..

Abby,

Are both eyes painful or just one?

Is it worse when you move your eye?

Has someone said that your eyes are dry?

regards,

Ahmed.

[abbygirl]

Ahmed,
I have a very complicated history..too long to get into here!! The pain is only in my left eye and it does not hurt when I move my eyeball. Both of my eyes are dry but this is a different type of pain. My left eye has had laser surgery to repair retina tears and also a very complicated IOL replacement surgery. I am also using a pressure drop only in that left eye. 99% of the time I wake up with this pain between 3 and 7 am and it always starts as an itchy burning pain that accelerates into a migraine like pain that radiates down my jaw and into the whole side of my face. The pain lasts 12-14 hours and then I am left with an eye that feels like it has been beat up and lots of surface pain. I have been to numerous doctors and no one can figure out. I am at my wits end. This is getting too long and there is more but thanks for reading and any input is appreciated.

[Ahmed]

Your right it sounds complicated, and I can see why your specialists are struggling, with so many things going on, its difficult to isolate the problem.

Is the anti glaucoma drop you use xalatan (latanaprost) ?

[abbygirl]

I use Timoptic in Ocudose 0.5%. It is BAK free and comes in individual vials. The drop is very irritating but I can't tell if this would be the cause of this pain. I can't use xalatan because it can cause inflammation after cataract surgery.

[Ahmed]

Sure, xalatan can increase the chance of inflammation at the back of the eye (which would be painless), however this is not why I was asking, xalatan is known to cause a mild sting/ache similar to that you are describing.

It could be so many different things, however be persistent with your appointments and Im sure you will find some relief. Additionally there are other meds that you may wish to research for nerve related pain, amitriptyline in a low dose appears to be useful.

Ahmed.