As a result of international evidence-based efforts of the TFOS DEWS II to redefine DED understanding, a novel category labeled “neuropathic dry eye” has risen. Neurosensory dysfunction is not routinely contemplated or assessed in practice, and should be suspected in the presence of sign-symptom disparity or persistence of complaints despite treatment adherence.
In this case, tear replacement/conservation therapies alone would have been futile, leading to perceived treatment failure. Instead, the identification of corneal nerve damage caused by the refractive procedures led to effective and long-standing symptomatic control with AST.
1. Friedman NJ. Impact of dry eye disease and treatment on quality of life. Curr Opin Ophthalmol 2010;21(4):310-6.
2. Qazi Y, Hurwitz S, Khan S, Jurkunas UV, Dana R, Hamrah P. Validity and Reliability of a Novel Ocular Pain Assessment Survey (OPAS) in Quantifying and Monitoring Corneal and Ocular Surface Pain. Ophthalmology 2016;123(7):1458-68.
3. Craig JP, Nichols KK, Akpek EK, Caffery B, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ, Tsubota K, Stapleton F. TFOS DEWS II Definition and Classification Report. Ocul Surf 2017;15(3):276-283.
4. Dieckmann G, Goyal S, Hamrah P. Neuropathic corneal pain: approaches for management. Ophthalmology 2017 (in press).
5. Goyal S, Hamrah P. Understanding Neuropathic Corneal Pain--Gaps and Current Therapeutic Approaches. Semin Ophthalmol 2016;31(1-2):59-70.
6. Theophanous C, Jacobs DS, Hamrah P. Corneal Neuralgia after LASIK. Optom Vis Sci 2015;92(9):233-240.
7. Understanding Neuropathic Corneal Pain--Gaps and Current Therapeutic Approaches. Goyal S, Hamrah P. 2016, Semin Ophthalmol, Vols. 31(1-2):59-70.
8. Altered sodium channel expression in second-order spinal sensory neurons contributes to pain after peripheral nerve injury. Hains BC, Saab CY, Klein JP, Craner MJ, Waxman SG. 2004, J Neurosci, Vols. 24(20):4832–14389.
9. Aggarwal S, Kheirkhah A, Cavalcanti BM, Cruzat A, Colon C, Brown E, et al. Autologous Serum Tears for Treatment of Photoallodynia in Patients with Corneal Neuropathy: Efficacy and Evaluation with In Vivo Confocal Microscopy. Ocul Surf 2015;13(3):250-62.