When Routine Eye Surgery Leads to Debilitating Pain [View all]

Kaylee Patterson woke with a sharp pain in her right eye the morning after she had Lasik surgery. She felt a dull ache on one side of her face... A year and a half after her surgery, Ms. Patterson finally learned why she was suffering. She has a condition known as neuropathic corneal pain, a specialist told her. The nerves in her cornea which had been cut as a routine part of Lasik surgery had become hypersensitive, producing agonizing pain.

It’s an unusual and sometimes severe complication of Lasik and other types of eye surgery. One form, called corneal neuralgia, can be hugely debilitating. Some patients report feeling as if they have fireballs or shards of glass in their eyes. Yet their eyes appear normal to most doctors who examine them. Seeing nerve damage requires a more high-powered microscope.

They often diagnose these patients with dry eye, another Lasik complication with some similar symptoms. The treatments usually aren’t enough, leaving many patients frustrated and in despair. Several patients unable to find relief from the pain have died by suicide. “These patients fall right through the cracks,” said Pedram Hamrah, an ophthalmologist and cornea specialist at Tufts Medical Center in Boston. “Neurologists are not trained to treat eye diseases, and ophthalmologists are not trained to treat neurological disease.”

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These cases have fueled new scrutiny of Lasik surgery, which can lead to other complications such as glare, halos or double vision. Surgeons who perform Lasik regularly say it is safe and bad outcomes are rare. An estimated 774,000 laser vision-correction procedures were performed in the U.S. in 2018, according to Market Scope, a market-research company specializing in the ophthalmic industry. They are on the rise again after peaking at nearly 1.5 million in 2007, then hitting a low in 2013 following the recession, according to Market Scope. An estimated 4.2 million cataract surgeries were performed in 2018.

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Ms. Patterson finally learned the source of her pain in May 2018, when she traveled to Boston and met with Dr. Hamrah. A scan with a microscope powerful enough to see her corneal nerves revealed clumps in the nerve endings of both corneas, she said. She has used eye drops made from her blood and says they have helped. Now living in Traverse City, Mich., closer to her family, she is working again. The pain remains “really dull and achy” and isn’t lessening anymore, she said. She has flare-ups. “If I have a really stressful day at work, I will have a pain episode and it will take two or three days to recover,” she said.

https://www.wsj.com/articles/when-routine-eye-surgery-leads-to-debilitating-pain-11562008367 (paid subscription)

Three stages (did not pass with the diagram)


Sensitization

1 Corneal nerves are damaged during eye surgery or another condition. Persistent inflammation can make the nerves hypersensitive.

Allodynia

2 Hypersensitive nerves can start firing on their own, causing pain for no particular reason. Corneal nerves regenerate poorly in people with this pain.

Pain from the brain

3 Over time, pain centers in the brain can start firing on their own, creating phantom pain in the cornea and areas other than the eye.