The essentially pain-free nature of LASIK is among factors it’s become the most popular form of corneal refractive surgery. There may a very small subset of LASIK clients who don’t enjoy this advantage after the procedure; rather they suffer from consistent eye discomfort postop, 20 20 Institute Denver and turn to the ophthalmologist for help. Here, professionals on pain in general and post-LASIK discomfort specifically discuss this rare phenomenon and ways to react if a client experiences it. Steven Wilson, MD, a surgeon at the Cleveland Clinic’s Cole Eye Institute, says he started to realize something was different about a small number of patients who were being described him. I have actually just had 3 clients who I’ve believed had it,” he states. They had actually been to three or four doctors and never appeared to be able to get relief. These were patients who appeared to have pain in their eyes that was escape of proportion to any of my findings in their eyes.
As Dr. Wilson alluded to, since some patients with LASIK-induced neurotrophic epitheliopathy, or LINE, can likewise have ocular discomfort, the clinician first has to rule out this condition when faced with a client with chronic eye pain. Most LINE patients do not have eye pain,” he says. The client with LINE might have a little discomfort at the flap edge where he still has some innervation, however it’s not this type of pain.
Dr. Wilson says his research study into this type of pain makes him think it’s closer to complex local pain syndrome, an entity that is known to strike anywhere in the body, and is more common after serious injuries. There appear to be some distinctions in CRPS in the eye vs. Chronic discomfort is more likely to happen not after surgical treatment however after other injury,” states pain specialist Michael Stanton-Hicks, MD, Dr. Wilson’s colleague at the Cleveland Clinic. Probably 70 percent of such pain is related to nerve injury, either metabolic, distressing or infective . The other major source of it in the United States is stopped working back surgery. It’s a completely different animal compared with acute pain, which is a normal physiologic reaction to some type of injury. Chronic pain is a overall reset of the nerve system to a chronic focus on whatever the start of the pain was. In Dr. Wilson’s LASIK patients, the cutting of the LASIK flap might have sufficed injury to touch off a persistent discomfort kind of reaction. I believe it originates from some type of abnormal regeneration of the nerves that get cut when you make the LASIK flap,” he says.
In the majority of patients, these nerves grow back perfectly normally; they might not have the same density in some individuals after their LASIK treatments, but they don’t have pain. LASIK-induced neurotrophic epitheliopathy can cause some ocular discomfort and, as such, must be eliminated as a medical diagnosis before the doctor can identify if a patient has persistent discomfort. This LINE case solved with treatment within two weeks. To make a definitive diagnosis and start a treatment routine, Dr. Wilson states you first need to get rid of any LINE. LINE is really responsive to anti-inflammatory treatment with topical cyclosporine, most likely due to the fact that in addition to the neurotrophic element, clients also have some underlying inflammatory dry eye,” he describes. So, when you deal with that swelling, their general condition gets better. You wouldn’t usually think about cyclosporine as being a medication that affects the neurotrophic part, though there have actually been some reports on how it can be a trophic factor for nerves, so you cannot exclude it entirely on that count.
Here, experts on discomfort in general and post-LASIK pain particularly discuss this unusual phenomenon and how to react if a patient experiences it. As Dr. Wilson alluded to, since some clients with LASIK-induced neurotrophic epitheliopathy, or LINE, can also have ocular pain, the clinician first has to rule out this condition when faced with a client with persistent eye discomfort. Dr. Wilson says his research study into this type of pain makes him think it’s closer to complicated local discomfort syndrome, an entity that is understood to strike anywhere in the body, and is more typical after serious injuries. There appear to be some distinctions in CRPS in the eye vs. Chronic discomfort is more likely to happen not after surgery however after other injury,” states pain expert Michael Stanton-Hicks, MD, Dr. Wilson’s colleague at the Cleveland Clinic. Persistent discomfort is a total reset of the nervous system to a persistent focus on whatever the start of the discomfort was.