Many patients who experience dry eye experience neuropathic eye pain— pain caused by nerve damage or nerve dysfunction that can’t be effectively treated with traditional approaches.
Below you can read more about various approaches to the treatment of peripheral and central neuropathic eye pain. There are treatments for both, but they are often under-recognized.
Peripheral Neuropathic Eye Pain Treatments
Firstly, any ocular surface abnormalities must be treated. The corneal nerves will often heal when the surface of the eye improves. This is the reason that we often see improvement in clinical signs before patients feel better. This takes time.
However, when pain persists, neuromodulatory approaches with eye drops and oral medications should be considered. It is important to understand that neuromodulation is a slow process that requires therapy for at least three months, with continued improvement for 1-2 years.
What about topical medications and treatments?
Anti-inflammatory medications often used to treat dry eye have also been shown to target peripheral neuropathic pain.
Autologous serum tears (AST) and platelet rich plasma (PRP) have neurotrophic factors and studies suggest they reduce the abnormal firing of injured peripheral nerves.
Oxervate (recombinant nerve growth factor) is the first drug approved by the FDA for neurotrophic keratitis, which is not the same as neuropathic pain, but they are similar. While there are no studies evaluating its effectiveness in treating neuropathic pain, patients with neuropathic eye pain often report improvement in their symptoms after an 8-week course and the effects persist for many months afterwards.
Cryopreserved amniotic membranes can also be used to treat neuropathic pain as they also contain neurotrophic factors and can significantly improve ocular surface pain. They are placed in the office and are typically left in place for 3-5 days. Unfortunately, they are not always well tolerated since the tissue is held in place by a ring, which can be uncomfortable.
Central Neuropathic Eye Pain Treatments
Oral Medications
Oral neuromodulators such as gabapentin and tricyclic antidepressants that regulate nerve function and reduce neuropathic pain signals can benefit patients with central neuropathic pain.
Gabapentin (Neurontin) and pregabalin (Lyrica) are commonly used to treat neuropathic pain. Fatigue and dizziness are common side effects but are lessened by slowly increasing the dose over time.
Low dose naltrexone blocks opioid receptors and in addition to helping with pain, it also has anti-inflammatory effects.
Adjuvant Therapy
Botulinum toxin type A (Botox) is approved to treat chronic migraine and patients with chronic migraines treated with Botox have noted improvement of light sensitivity and dryness. A modified protocol has been used to treat severe light sensitivity with a positive response. Transcutaneous and electrical nerve stimulation (TENS units) and periocular nerve blocks have also shown promise.
Psychological Support
Chronic neuropathic eye pain can significantly impact an individual's quality of life and mental well-being. Psychological interventions such as cognitive-behavioral therapy (CBT) or counseling may help patients cope with pain, stress, and emotional distress associated with their condition.
Have Questions? Dr. Zimski Has Answers!
Treating eye pain requires a balance of addressing issues on the ocular surface and the underlying nerve dysfunction associated with it. It’s a bit like putting a puzzle together piece by piece, but with the right treatments and enough time, we can make a huge impact on quality of life.
So, if you're dealing with persistent neuropathic eye pain, we can help. The office of Dr. Lauren Zimski will work closely with you to find a solution that works for you. Book an appointment online or call us at 303-863-1231 today.