Do you remember what happened when your doctor was searching for a reason for your chronic eye pain? Did you hear the word “neuropathic”? Maybe your doctor prescribed pain medication. Did you take it? And did the pain stop but then return when you stopped taking the pain meds?
If this scenario sounds familiar, it’s because some doctors, ophthalmologists and optometrists alike, are now saying “neuropathic eye pain” is the cause of mysterious eye pain in the Dry Eye patient. They refer to the phenomenon as “pain without stain.” They explain that it’s a problem with the patient’s nerves. So the brain “feels” pain even when there is nothing there to cause the pain.
Reasons to Doubt Neuropathic Pain Diagnosis
It may sound plausible, but in fact there are plenty of reasons to doubt a diagnosis of neuropathic eye pain. The reasons are numerous. For example, a doctor’s diagnostic techniques may be poor, so they miss a multitude of possible ocular surface comorbidities that might be causing pain or other discomfort.
Test results may be inaccurate so even something simple like aqueous tear deficiency can be easily missed. This can happen when a Schirmer’s test or fluoresceine clearance test (FCT) is improperly administered or too swiftly abandoned (as when a test is administered just once instead of several times in succession, as necessary). Or it can be because the challenge test for pain, instilling anesthetizing drops in the eye, doesn’t actually numb parts of the ocular surface that are diseased, sometimes severely diseased and highly sensitive. So the eye will never go numb with topical eye drops.
It can be due to a reliance on fast and easy but not specific tests. An osmolarity test, for example, may indicate that tear osmolarity is sub-optimal, but what does that actually mean? Is a specific disease indicated? Maybe it is because of aqueous tear deficiency, but maybe it’s because of something else! Similarly, MMP-9 testing may indicate some level of inflammation, but why? What is underlying this positive test for the presence of inflammation, if, in fact, it is accurate?
Successful reversal of neuropathic eye pain
In his recently published paper, Dr. Steven L. Maskin describes three patients who had been diagnosed with ocular neuropathic pain by other doctors. The usual treatments were prescribed, but the patients didn’t improve. When they finally saw Dr. Maskin, and had all of their comorbidities diagnosed and treated with targeted treatments, these patients finally found relief for their debilitating and painful symptoms.
Now, I will admit much of what Dr. Maskin writes is way over my head with technical and medical words I don’t always understand. But that said, I am sure the doctors who need to read this will understand it. And if they do, they will get better at diagnosing and treating these types of patients with massive, chronic pain. If your doctor gave you a diagnosis of neuropathic eye pain, maybe you could take a copy of Dr. Maskin’s article to them and see what they think about it.
A summary of the full article in plain English is available here, at the National Library of Medicine Pub Med.
If you want to take the deeper dive into patient’s situations, the diagnosis/treatment details and yes, all of the medical terms you can find it here at the American Journal of Ophthalmology Case Reports.
The good news is there are better ways to diagnose and treat patients with chronic ocular surface pain. You can learn even more about these better approaches in the book Your Dry Eye Mystery Solved: Reversing Meibomian Gland Dysfunction, Restoring Hope.
If you think you would like to connect with one of our Patient Advocates to sort things out, at no cost to you, via email or by telephone just fill out this short form here.
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