ASCRS 2026: Neuropathic corneal pain and the evolving ocular surface landscape

Ocular surface disease continues to expand as a focus of clinical care, with increasing attention to diagnosis, disease subtypes, and emerging therapies. Christopher E. Starr, MD, FACS, of Weill Cornell Medicine in New York City, emphasized that dry eye should be viewed within a broader framework, noting that ocular surface disease “is the term I like to use,” with dry eye representing only one component of a larger spectrum.

At the American Society of Cataract and Refractive Surgery (ASCRS) 2026 annual meeting, Starr co-moderated a session focused on “less severe” ocular surface disease, complementing a parallel session on more advanced pathology. The discussion centered on common, day-to-day presentations seen in clinical practice, which he described as “the most common diagnosis any ophthalmologist sees on a day-to-day basis.” Topics included meibomian gland dysfunction, diagnostic tools, and a growing pipeline of treatments. Starr underscored the pace of innovation, noting that “every year, we have all these new approvals, all these new devices, all these new diagnostic tools, all these new treatments.”

Expanding the framework of ocular surface disease

He noted that the field has evolved beyond traditional categorization, adding, “this is a subspecialty of ophthalmology unto itself… it is ocular surface disease, and it deserves its own subspecialty.” Within this evolving landscape, he highlighted a key diagnostic gap: neuropathic corneal pain. In his academic practice, among patients referred for persistent dry eye symptoms after seeing multiple providers, “the diagnosis of neuropathic corneal pain was diagnosed in about ninety percent of those patients.” He emphasized that this condition is frequently overlooked, even by specialists, and that “failing to diagnose it and failing to treat it is a tremendous disservice.”

Neuropathic corneal pain: A critical diagnostic consideration

Starr described neuropathic corneal pain as a severe manifestation of ocular surface disease that can significantly affect quality of life. As a clinical takeaway, he advised physicians to “always be thinking about the corneal nerves and in particular, neuropathic corneal pain,” especially in patients who remain symptomatic despite multiple therapies.

Emerging therapies and pipeline development

Emerging therapeutics were also discussed. Reproxalap, described as “a unique and novel anti-inflammatory… that works upstream in the inflammatory cascade,” has been under development but has faced regulatory challenges. “It has been rejected by the FDA in various forms over the years,” he noted, adding that efforts are ongoing and that he continues to anticipate its potential role in treatment. He also highlighted investigational therapy targeting neuropathic corneal pain, noting that there are currently no FDA-approved options. A compound under development shows “very promising” data, particularly for peripheral disease, where topical therapies may be more effective.