47
EW FEATURE
November 2018 • Improving the ocular surface for cataract and refractive surgeons
that is implanted in the abdomen.
Successful, long-lasting control of
the pain can be achieved with this
modality.
Mental health consult
Dr. Galor takes a holistic view of the
condition as ocular manifestations
are often one component of a sys-
temic disease.
"Corneal nerves are connected
to the brain, both to the sensing part
as well as the limbic system, which
is responsible for the emotional
response to pain," Dr. Galor said.
"That is why it is important to con-
sider emotional status when treating
patients with keratoneuralgia."
Many patients with keratoneu-
ralgia often readily acknowledge
depression and anxiety associated
with their chronic pain.
"I tell them that those emotions
need to be managed by a psychol-
ogist, psychiatrist, or primary care
physician," Dr. Galor said.
Dr. Sayegh said a psychiatric
consultation is beneficial for patients
whose pain is generalized rather
than localized to the eye, especially
if it is associated with significant de-
pression or anxiety or if the patient
is suicidal.
Every patient undergoes a psy-
chiatric evaluation prior to implan-
tation of the intrathecal delivery
system, Dr. Sayegh noted.
Preop screening
Unfortunately, there is no reliable
way to screen for patients who will
develop ocular neuropathic pain
postoperatively, Dr. Sayegh said.
"We hope more research is done
on this topic and on developing
preventative strategies that will min-
imize the likelihood of developing
postoperative neuropathic pain in
susceptible individuals," Dr. Sayegh
said.
Despite the lack of universally
predictable screening, Dr. Galor not-
ed that chronic pain doesn't exist
in isolation, so patients with a long
history of pain—especially chronic
widespread pain like fibromyalgia—
are likely at higher risk for develop-
ing eye pain.
"Any surgery damages corneal
nerves. We think that abnormal
nerve healing occurs in some indi-
viduals, with resultant persistent
pain. While the incidence of severe
pain after surgery is low, when it
does occur, it can significantly im-
pact a patient's quality of life," Dr.
Galor said. EW
Editors' note: Drs. Galor and Sayegh
have no financial interests related to
their comments.
Contact information
Galor: agalor@med.miami.edu
Sayegh: rony.sayegh@case.edu
