Neuropathic corneal pain is more common than previously thought and should be considered when discomfort in or around the eyes persists despite appropriate treatment. An individual who has a neuropathic component to his/her condition can experience discomfort, even pain, to normal stimuli such as light (photophobia), air, wind, etc.
Causes of Neuropathic Corneal Pain:
Neuropathic corneal pain can result from any condition which causes corneal nerve damage, or damage to the nerves surrounding the eyes. This can include, but is not limited to: previous eye surgery, chronic inflammation due to dry eye, environmental allergies, blepharitis, meibomian gland dysfunction, ocular rosacea, long time contact lens wear, toxicity from preservatives in eye drops, radiation therapy, shingles, diabetes, trigeminal neuralgia, etc.
The damaged corneal nerves can trigger inappropriate pain signals back and forth to the brain, hence the central nervous system component.
Medical Conditions Associated With Neuropathic Pain:
The incidence of neuropathic corneal pain has been noted to be higher in patients with a history of migraines and other types of headaches, autoimmune conditions, anxiety, depression, chronic fatigue syndrome, temporomandibular joint issues, irritable bowel syndrome, alcoholism, chemotherapy, diabetes, HIV, multiple myeloma, multiple sclerosis, nerve compression associated with herniated discs, shingles, thyroid problems, and/or (small fiber) fibromyalgia.
Treatment of Neuropathic Corneal Pain:
In addition to reducing inflammation of the ocular surface using treatments such as topical anti-inflammatory medications, amniotic membranes, autologous serum, topical recombinant corneal nerve growth factor (Oxervate), and others, effective treatment of neuropathic corneal pain must also target the central component using medications such as Gabapentin, Cymbalta, Naltrexone, and/or Lyrica.