When routine eye surgery causes debilitating pain

A year and a half after her operation, Ms. Patterson finally learned why she was in pain. She suffers from a condition known as neuropathic corneal pain, a specialist told her. The nerves in her cornea that had been severed as part of the Lasik surgery had become hypersensitive, producing excruciating pain.

It is an unusual and sometimes serious complication of Lasik and other types of eye surgery. One form, called corneal neuralgia, can be extremely debilitating. Some patients report having the impression of having fireballs or shards of glass in their eyes. Yet their eyes appear normal to most doctors who examine them. Seeing nerve damage requires a more powerful microscope.

They often diagnose these patients with dry eye, another Lasik complication with similar symptoms. Treatments are usually not enough, leaving many patients frustrated and desperate. Several patients unable to find pain relief have died by suicide.

Painful state

The cornea has a higher density of nerves than any other tissue in the body. Nerve damage can lead to a debilitating disease known as neuropathic corneal pain. Here is how it evolves.

Corneal nerves are damaged during eye surgery or some other condition. Persistent inflammation can make nerves hypersensitive.

Hypersensitive nerves can start to pull on their own, causing pain for no particular reason. Corneal nerves regenerate poorly in people with this pain.

Over time, the pain centers in the brain may start to fire on their own, creating phantom pain in the cornea and areas other than the eye.

Corneal nerves are damaged during eye surgery or some other condition. Persistent inflammation can make nerves hypersensitive.

Hypersensitive nerves can start to pull on their own, causing pain for no particular reason. Corneal nerves regenerate poorly in people with this pain.

Over time, the pain centers in the brain may start to fire on their own, creating phantom pain in the cornea and areas other than the eye.

Corneal nerves are damaged during eye surgery or some other condition. Persistent inflammation can make nerves hypersensitive.

Hypersensitive nerves can start to pull on their own, causing pain for no particular reason. Corneal nerves regenerate poorly in people with this pain.

Over time, the pain centers in the brain may start to fire on their own, creating phantom pain in the cornea and areas other than the eye.

Corneal nerves are damaged during eye surgery or some other condition. Persistent inflammation can make nerves hypersensitive.

Hypersensitive nerves can start to pull on their own, causing pain for no particular reason. Corneal nerves regenerate poorly in people with this pain.

Over time, the pain centers in the brain may start to fire on their own, creating phantom pain in the cornea and areas other than the eye.

“These patients fall through the cracks of the net,” said Pedram Hamrah, ophthalmologist and cornea specialist at Tufts Medical Center in Boston. “Neurologists are not trained to treat eye disease, and ophthalmologists are not trained to treat neurological disease.”

He and other doctors and researchers are trying to find better ways to identify patients at risk, raise awareness of the disease, and research new treatments. It is not known how common neuropathic corneal pain is. No epidemiological studies have been conducted on this specific condition, say the researchers, although there have been studies of discomfort in the eyes after Lasik surgery. Some say it’s rare, occurring in less than 1% of patients who have had Lasik surgery, but doctors say they’re seeing more patients, perhaps as awareness increases.

Stephen Pflugfelder, a corneal specialist and professor of ophthalmology at Baylor College of Medicine in Houston, said he sees a few new patients with the disease every month. He assumes that this occurs in 1% to 2% of patients who undergo Lasik surgery. “I think it is more widespread than what is recognized,” he said.

Dr Hamrah said he sees up to 200 new patients a year with neuropathic corneal pain. They come from all over the world and the vast majority – 75% – have developed the disease after eye surgery, he said. Of these, 20% had Lasik. More patients develop neuralgia after cataract surgery, he said, but Lasik patients experience more severe pain.

These cases have fueled a new scrutiny for Lasik surgery, which can lead to other complications such as glare, halos or double vision. Surgeons who regularly perform Lasik say it is safe and poor results are rare. An estimated 774,000 laser vision correction procedures were performed in the United States in 2018, according to Market Scope, a market research company specializing in the ophthalmic industry. They are on the rise again after peaking at nearly 1.5 million in 2007, then bottoming in 2013 following the recession, according to Market Scope. An estimated 4.2 million cataract surgeries were performed in 2018.

“Truly modern Lasik is safe and effective,” said Stephen Slade, surgeon at Slade & Baker Vision in Houston, who has been practicing Lasik procedures since 1991. The field is concerned about neuropathic corneal pain and is trying to find out more, Dr Slade said. . “We are trying very hard to find out how we can help. ”

The Food and Drug Administration has declared Lasik safe, but did not respond to a request for comment on neuropathic corneal pain.

Paul Madsen, marketing director in Eagan, Minn., Developed pain behind his left eye about six weeks after his Lasik procedure in April 2018. It has spread beyond his ear and down his cheek. His doctor told him he had dry eyes and that it was part of the healing process, said Mr Madsen, 32. The pain was so severe that he had to quit his job for several weeks. “It’s like someone stabs you in the eye and shakes the knife,” said Madsen, who also had other complications such as “rainbow glare” , in which he would see a spectrum of colored bands emanating from a light source. .

Over the past year, he has spent tens of thousands of dollars on treatments. They include surgeries that block the nerves, anti-epileptic drugs to calm the nerves, and eye drops made from one’s own blood which are meant to stimulate nerve growth. Although the condition has improved, “I am still distracted with the pain,” he said.

Ms Patterson had Lasik surgery in December 2016 because she played sports, traveled often and worried about losing her contact lenses. As her pain increased after the operation and a follow-up procedure, she had to quit her job, she said. She felt a throbbing pain deep in her head and her face felt like it was wrapped in plastic wrap. “I spent months in a dark room because the lights hurt so much, the TV screens hurt, the air hurt,” she said. Sometimes she wanted to end her life. “Living with this pain was not living,” she said.

She finally learned the source of her pain in May 2018, when she traveled to Boston and met Dr. Hamrah. A scan with a microscope powerful enough to see her corneal nerves revealed tufts in the nerve endings of both corneas, she said.

She used eye drops made from her blood and says they helped. Now living in Traverse City, Michigan, closer to her family, she is working again. The pain remains “really dull and aching” and doesn’t go away anymore, she said. She’s having flare-ups. “If I have a really stressful day at work, I will have a painful episode and it will take me two or three days to recover,” she said.

Dr Hamrah said there was hope for patients with neuropathic corneal pain. There are pain relievers and other potential treatments in development, he said. “I expect there will be a lot of new stuff to come in the next 10 to 15 years,” he said.