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Eye - Corneal neuropathic pain: a review to inform clinical practice gabapentin was commenced at 300 mg orally daily and increased to 600–900 mg three times a day and pregabalin was Purpose: To investigate the response to gabapentin treatment in patients with dry eye (DE) accompanied by features of neuropathic ocular pain (NOP), and to analyze the differences between clinical manifestations of the groups according to treatment response. ODs who treat dry eye or listen to patients complaining of eye pain are likely to encounter patients suffering from neuropathic pain. Neuropathic pain is a loss of homeostasis within the central nervous system. It was referred to in the Dry Eye Workshop (DEWS) II definition of dry eye 1: Neuropathic pain is caused by a primary lesion or dysfunction of the nervous system and can occur in the cornea. However, neuropathic corneal pain (NCP) is currently an ill-defined disease. Patients with NCP are extremely challenging to manage, and evidence-based clinical recommendations for the management of patients with NCP are scarce. The objectives of this review are to provide guidelines Purpose: To investigate the response to gabapentin treatment in patients with dry eye (DE) accompanied by features of neuropathic ocular pain (NOP), and to analyze the differences between clinical manifestations of the groups according to treatment response. Methods: We retrospectively reviewed the records of 35 patients with DE accompanied by NOP features and obtained information on their Triggers that lead to corneal nerve damage result in corneal neuropathy. Damage to nerves during refractive surgeries, ocular surface diseases such as chronic dry eye disease, recurrent corneal erosions, corneal neuropathic infections such as herpetic simplex and zoster, systemic neuropathic conditions such as diabetes, exposure to topical and systemic drugs, radiation keratopathy and We report a 37-year-old male presenting with constant left eye pain associated with headaches, whose pain was successfully reduced after 3 weeks of treatment with gabapentin. Our case and literature review highlight the importance of gabapentin and thorough psychosocial evaluations in patients with chronic neuropathic ocular pain. Furthermore, among anti-epileptics used for chronic pain, clinical trial evidence supported the use of only gabapentin and pregabalin in some neuropathic pain conditions (painful diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain) and fibromyalgia [24••]. Evidence supporting the use of tricyclic antidepressants is Ocular neuropathic pain is a diagnosis of exclusion which refers to the heightened perception of pain in response to normally non-painful stimuli. It usually presents without any visible objective exam findings, making it extremely difficult to identify.[1] For this reason, it often gets misdiagnosed as dry eye disease. A recent study reported that oral gabapentin may be able to successfully treat DED patients with neuropathic ocular pain—as opposed to pain mainly caused by mechanical and chemical influences—who have systemic comorbidities, including rheumatological, neurological and psychological disorders. Current medication management for neuropathic pain includes select neuromodulating agents such as anticonvulsants, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and certain opioids. 1,2 Gabapentin remains among the most commonly used anticonvulsants for neuropathic pain. This study aims to evaluate the efficacy of gabapentin treatment in dry eye disease (DED) and neuropathic ocular pain. Our study was performed with 72 patients. The painDETECT questionnaire was used for neuropathic pain screening. Patients who were thought to have severe DED according to ocular surface disease index (OSDI) questionnaire, Schirmer’s test type 1 and tear break up time test Oral gabapentin is a first-line treatment for chronic systemic neuropathic pain. Although it has been used for ocular discomfort after refractive surgery and in severe, painful dry eye syndrome (DES), it can depress the central nervous system. Gabapentin may be an underutilized medication in the treatment of chronic ocular pain. The pathophysiology of neuropathic ocular pain remains poorly understood. Clinical evaluation often reveals minimal ophthalmic exam findings, leading to an underdiagnosis of the condition by ophthalmologists. The present study stems from the consideration that anesthetics are not best indicated to fight neuropathic ocular pain, especially in case of dry eye, because they are expected to blunt the nervous feedback between the cornea and the lacrimal apparatus, thus inhibiting lacrimation. Dry eye patients should be screened for neuropathic ocular pain symptoms and individualized treatment has to be applied. Our study showed that the use of gabapentin is effective in severe dry eye patients with neuropathic ocular pain. Though Gabapentin remains well established as a first-line treatment for diabetic neuropathy, 14, 15 few randomized control studies have examined the utility of the drug in corneal neuropathic pain. 16 Ongun et al. showed a decrease in patient reported pain in a cohort of patients with chronic corneal neuropathic pain and dry eye disease Other support of local nerve recovery. Autologous serum tears and amniotic membrane can be used to promote recovery of nerve structure and function. Systemic suppression of central sensitization. To block the “learning” of pain, the following systemic agents can be used: Gabapentin and pregabalin. Gabapentin is an antiepileptic used for neuropathic pain treatment. Glaucoma can be conceptualized an optic neuropathy associated with characteristic structural damage to the optic nerve and associated visual dysfunction. Ocular neuropathic pain, also called corneal neuralgia, is a spectrum of disorders of ocular pain which are caused by damage or disease affecting the nerves.Ocular neuropathic pain is frequently associated with damaged or dysfunctional corneal nerves, [1] but the condition can also be caused by peripheral or centralized sensitization. [2]
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