Identifying Neuropathic Ocular Pain Indicators Post-LASIK Surgery

Recent research published in the August issue of the American Journal of Ophthalmology has shed light on key diagnostic markers for chronic neuropathic ocular pain (NOP) in patients suffering from persistent dry eye symptoms following LASIK surgery. This study aimed to differentiate between patients with post-LASIK dry eye who develop NOP and those who do not, providing valuable insights for targeted diagnosis and treatment.

The prospective cross-sectional study involved 89 patients classified into three groups: 34 with both dry eye and NOP, 25 with dry eye alone, and 30 asymptomatic LASIK patients. Researchers assessed various clinical parameters, including symptom severity, pain levels, use of ocular lubrication, and psychological factors such as anxiety and depression. The NOP group exhibited significantly higher dry eye symptoms, elevated pain scores, and increased use of ocular lubricants. Additionally, they showed greater incidences of anxiety, depression, and central sensitization syndromes.

A notable finding was that patients with NOP demonstrated heightened tactile sensitivity of the cornea even after topical anesthesia, indicating nerve hypersensitivity. Confocal microscopy revealed these patients had reduced nerve density and an increased density of microneuromas within the sub-basal nerve plexus, correlating with clinical pain and symptom measures. These nerve alterations appear to serve as reliable indicators for diagnosing neuropathic pain post-LASIK.

The study concludes that higher corneal tactile sensitivity following anesthesia, decreased nerve density, and increased microneuroma presence in the corneal nerve plexus are significant signs of NOP in post-refractive surgery patients. These findings propose that nerve imaging and sensitivity testing could improve early diagnosis and management of this condition, ultimately enhancing patient outcomes.

Two of the authors disclosed connections to the biopharmaceutical industry. For further details, see the original study: Amanda Vázquez et al, "Corneal Sensory Changes and Nerve Plexus Abnormalities in Chronic Neuropathic Ocular Pain and Dry Eye Postrefractive Surgery," American Journal of Ophthalmology (2025).