Corneal Neuralgia

[Tramadeezy]

New patient, young lady with several years of burning/irritating eye pain after Lasik. Has tried a bunch eye drops and Gabapentin with no relief. She would like to try interventions. Any experience with TN block for this? Can you reliably catch V1? Any thoughts appreciated, thanks.

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[lobelsteve]

Never seen it. V1 easy to get.
Use this article..

 

[Tramadeezy]

Thanks. I was thinking TN block. Any reason to consider sphenopalatine vs TN? Maybe catch some parasympathetics with sphenopalatine? Might try q-tip spheno first and see what happens.

 

[Agast]

It's probably dry eye and it's a known risk of Lasik. She needs to use her eye drops. She can get amniotic membrane treatment if she wants to be fancy and insurance will cover some of it.

 

[Tramadeezy]

The dryness does bother her but eye drops help that. Its more burning/throbbing pain that is the worst part.

 

[NJPAIN]

What’s the next step after TN block if you get transient relief? RF of V1? I thought the was considered to be a really bad idea.

 

[NJPAIN]

What’s the next step after TN block if you get transient relief? RF of V1? I thought the was considered to be a really bad idea.

I think I would try another drug or two before going down that path and the potential pitfalls.

 

[GlowInTheDark]

Intrathecal catheter targeting C1 has been described/performed...that was the last ditch after other options they tried

Successful Management of Corneal Neuropathic Pain with Intrathecal Targeted Drug Delivery - PubMed

Intrathecal delivery of bupivacaine and low dose fentanyl in the upper cervical spine can be effective in controlling refractory eye pain in properly selected patients and treatment centers.

pubmed.ncbi.nlm.nih.gov