Corneal Neuropathy

[Sherri22]

Hi - New here, just finding my way around. Diagnosed with DED a few months ago, getting some results with 3 rounds of IPL, but eyes are still inflamed and contact lens wear is impossible. The doctor says oil is coming out at the thickness of butter. Maybe it was just too soon for contacts, but he is surprised I was so intolerant. Searched and found a lot of info on corneal neuropathy, but not much very recent. Any info on this condition vs DED? I'm thinking I need to get checked out for it.

[PRK]

Here are a couple links most of them are outdated though.

https://www.eyeworld.org/article-tre...plainable-pain

http://eyewiki.aao.org/Ocular_Neuropathic_Pain

https://www.aao.org/eyenet/article/a...eal-neuropathy


Management Options

Ocular surface treatment
· Eye lubrication and treatment of dry eye – like symptoms: Artificial tears are used to prevent surface dryness and provide symptomatic relief. By decreasing the hyper-osmolarity of tears, over-stimulation of the nociceptors is stopped. Tears, ointments and gels are all used depending on patient tolerance. If used more than 4 times, preservative free tears are recommended. Punctal plugs to increase the tear lake are also useful.
· Topical and systemic antibiotics to treat blepharitis are often used. Systemic fish oil or flax seed oil to treat evaporative component of dry eye disease has also been used.
· Scleral lenses Scleral lenses, specifically prosthetic replacement of the ocular surface ecosystem (PROSE) has been shown to be effective in treatment of post LASIK corneal neuralgia. The PROSE devices are made of rigid gas permeable lenses, are custom designed and provide fluid ventilation to the cornea.³⁴ Figure 9.

• Figure 9: Boston Sight PROSE Device Image Credit: Boston Sight

Anti-inflammatory therapies

• Steroids: Short courses of topical steroids have been shown to be useful to decrease surface inflammation. This works both to stop the vicious cycle of inflammation and nerve damage and also provides symptomatic relief. Generally these agents are tapered and discontinued once the inflammation is controlled to prevent formation of cataracts and increased intraocular pressure. Steroids with decreased ocular side effects like fluorometholone and loteprednol are preferred.
• Non-steroidal anti-inflammatory therapies: Topical cyclosporine 0.5% has been shown to decrease the surface inflammation. Also a new drug –lifitegrast has been shown to decrease surface inflammation. These agents modulate T cell mediated inflammation.

Neuro-regenerative therapy
Autologous serum tears – These therapies target the underlying pathophysiology of aberrant nerve regeneration subsequent to repeated injury in neuropathic pain. Various neurotrophic growth factors and epithelial growth factors such as the nerve growth factor (NGF), insulin-like growth factor-1, transforming growth factor β, fibronectin, substance P and epidermal growth factor, which help in proliferation, differentiation and maintenance ocular surface health, are present in high concentrations in serum tears.^35,36 NGF is present in high concentrations in serum compared to tears and plays an important role in nerve regeneration and restoration of function of nerves.^37-41 Serum tears are also effective in dry eye and neurotrophic conditions of the cornea.^42-46 Figure 10.