Treatment options for Corneal Neuralgia from Dr. Jacobs at Boston Foundation

[Katewest]

Dr. Jacobs at the Boston Foundation for Sight is an amazing DR. She called me yesterday explaining a fax she just sent to me and my local doc regarding the corneal neuralgia diagnosis. She interpreted the confocal microscopy I had done at Mass eye and ear. The results were "evidence of bilateral neuropathy, with moderate and at times focal decrease in nerve density. Mostly with loss of branching. Also has increased tortuosity, presence of neuromas, beading, and focal areas of hyperreflective nerves". All that means that from the little they understand of corneal neuralgia they do think the scan came back abnormal. Thats how she explained it. Here are there recommendations moving forward:

Serum tears
daily wear soft contacts such as acuvue mosit one a day ( Dr. L also recommended this)
Lacriserts (some people like them so don't)
low dose soft steroid (FML, Lotemax)
acupuncture
Systemic treatment for neuralgia ie gabapentin, pregabalin, tramadol )

Hope this helps anyone thinking they might have this.

[kylix]

serum + contacts? How? I thought serum can't be put in when contacts are on, or am I wrong?
Moreover I thought wearing contacts can also cause it. Would you be please so kind and described what caused (or you think caused) your problems? Coz I also suspect the same thing (that I have neuralgia) introduced by wearing contacts for 12 years.

Could you also please describe how it was going during confocal m.? I asked for it at local hospital and had it but probably just somehing slightly different. They told me I had confoscan but evaluated just some endothelium (or something like that), which was good according to them.
Thank you.

[Katewest]

I'm not sure about serum and contacts at the same time but I'll ask my doc. The confocal microscopy was not bad at all. They but numbing drops and gel in your eyes then take a microscope like device to take pics of both eyes. Took about 10 minutes. I think my eye problems are mild ocular rosacea and maybe allergies. Maybe hormonal ? Not really sure bc I've never had LASIK surgery

[Cali]

Do you know if they can look at your glands in a confocal? I think I read on a previous post that the confocal was able to determine something about lacrimal or meibomian glands?

[Katewest]

I don't think so and they didn't mention my glands or touch any part of my eye lid

[Guest]

Do you know if they can look at your glands in a confocal? I think I read on a previous post that the confocal was able to determine something about lacrimal or meibomian glands?

My experience with confocal microscopy at BFS was the same as Katewest - they only used it to look at my corneal nerves.

[Katewest]

Saag- what were your results and what treatment did you do? I brought my treatment notes from Dr. Jacobs to my local Optho who basically threw it in the trash except for a referral for serum tears.

[buntbean]

I noticed the same thing as Katewest. My Boston eye doctor laughed when I told him I was diagnosed with corneal neuralgia. My experience at Boston Foundation for Sight was encouraging, yet I still have been unable to find an eye doctor that treats it in the Massachusetts area.

[debbrancheau]

Is a confocal microscopy different than when an ophthalmologist uses a slit lamp? When i asked one of my docs for a confocal microscopy he said that that was what he did when he used his slit lamp.

[buntbean]

Is a confocal microscopy different than when an ophthalmologist uses a slit lamp? When i asked one of my docs for a confocal microscopy he said that that was what he did when he used his slit lamp.

The confocal is completely different than slit lamp. It's a specialized microscope that takes pictures of your cornea. I believe there are only 2 in Massachusetts. 1 at Mass Eye and Ear and 1 at Boston Foundation for Sight. I would think it's like comparing an Xray to an MRI (but I'm no specialist).