Chronic pain syndrome: A new postLASIK entity?

November 7, 2008

Refractive surgeons may consider the diagnosis of LASIK chronic pain syndrome in postLASIK patients complaining of moderate to severe eye pain in the absence of dry eye or any other identifiable cause, said Steven E. Wilson, MD.

Refractive surgeons may consider the diagnosis of LASIK chronicpain syndrome in postLASIK patients complaining of moderate tosevere eye pain in the absence of dry eye or any otheridentifiable cause, said Steven E. Wilson, MD.

Dr. Wilson, director of corneal research, Cole Eye Institute,Cleveland Clinic, Cleveland, OH, presented his hypothesis thatrare patients can develop an ocular reflex sympathetic dystrophyas a result of corneal nerve injury induced by LASIK. Although itremains to be proven whether this chronic pain syndrome exists,he proposed it as being a type of complex regional pain syndromewith nonspecific manifestations and no objective signs. Dr.Wilson said it is distinct from denervation hypersensitivitysyndrome, a transient disorder that all patients experience afterLASIK and PRK but that resolves within a few months.

Support that LASIK chronic pain syndrome is a real entity isprovided by a recent study by Moilanen et al. who found inprospective follow-up of LASIK patients that nerve density wasonly 64% of the preoperative value at 2 years after theprocedure. These investigators also reported confocal microscopyevidence of abnormal nerve regeneration in some patients.

"Patients complaining of chronic pain in the absence of anyclinical findings are sometimes written off as difficult orcrazy," Dr. Wilson said. "However, if you have a patient withthese features and all other attempts at management have failed,consider working with a pain management specialist to institute atrial with one of the anticonvulsant medications that are beingused for complex regional pain syndrome."