How do you explain it?...
Chronic or delayed ocular pain following refractive surgery, even with a seemingly perfect surgical outcome is a concern for us, often presenting complex diagnostic and management challenges.
Post-operative pain can stem from various sources. The severity and duration of pain can vary widely, ranging from mild discomfort to debilitating photophobia and foreign body sensation. Notably, a subset of individuals may experience chronic (or recurrent) pain syndrome, persisting beyond the expected healing period.
Etiologies can include induced neurotrophic keratopathy (corneal neuralgia), inflammatory dry eye, persistent epithelial defects, and others. Differential diagnosis is key, as symptoms may mimic those of more serious complications such as diffuse lamellar keratitis or infectious keratitis. Management strategies typically involve a multi-modal approach, combining topical lubricants, anti-inflammatory agents, and in rare cases, amniotic membrane grafts or autologous serum tears.
Recent finidings in corneal neurobiology have pointed to various mechanisms of post-surgical pain, paving the way for new therapeutic approaches. Emerging treatments, such as topical nerve growth factors and corneal neurostimulation, show promise in refractory cases. Of course, appropriate pre-op counseling and post-op care is very important in optimizing outcomes and comfortable patients.
-JRM
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