# International Survey of Current Approaches to the Management of Neuropathic Corneal Pain by Experts

## TL;DR

This study surveyed eye specialists worldwide to understand how they diagnose and treat neuropathic corneal pain, revealing varied approaches and a need for clearer guidelines.

## Contribution

The paper provides the first international survey of expert practices in managing neuropathic corneal pain, highlighting diagnostic and therapeutic variability.

## Key findings

- Chronic ocular surface disease and post-surgical factors are most commonly reported causes of neuropathic corneal pain.
- Artificial tears, serum-derived tears, and topical corticosteroids are the most frequently used treatments.
- Only a minority of specialists feel confident prescribing systemic pharmacotherapy for neuropathic corneal pain.

## Abstract

Neuropathic corneal pain (NCP) is a challenging condition with limited consensus on its diagnosis and management. This study aimed to gather global insights from corneal specialists on the causes, investigative approaches, and management strategies for NCP.

A 32-question survey covering demographic, causes, investigations, treatments, and multidisciplinary engagement was sent to 152 invited international corneal specialists; 51 (34%) responded. We explored descriptive statistics and examined how responder characteristics influenced their answers.

The most reported causes of NCP were chronic ocular surface disease (n = 41; 41%) and post-surgical factors (n = 34; 34%). The most common investigations, routinely performed by respondents, were the anesthetic challenge test, Schirmer’s test, and corneal esthesiometry. In vivo confocal microscopy (IVCM) was routinely used by 37% (n = 19), with 69% (n = 29) of specialists stating that an abnormal result influenced their management. Ocular surface and pain questionnaires were used by 69% (n = 35), with the Ocular Surface Disease Index being the most popular (n = 25; 31%). Common treatments included artificial tears (n = 48; 94%), serum/plasma-derived tears (n = 41; 80%), topical corticosteroids (n = 34; 67%), and topical cyclosporin (n = 30; 59%). Only 38% (n = 19) felt comfortable independently prescribing systemic pharmacotherapy. A multidisciplinary approach was adopted by 47% (n = 24), with the two most common specialties involved being pain management (n = 30; 37%) and neurology (n = 26, 32%).

This survey provides valuable global insights into the causes, investigations, and management of NCP from the perspective of corneal specialists. These findings support further research and the development of guidelines to address this challenging condition.

Neuropathic corneal pain is a challenging condition due to patients reporting very significant eye pain even when there is no obvious problem on the eye’s surface when examined. This study asked eye doctors, specifically corneal pain specialists, worldwide about the causes of neuropathic corneal pain, their investigative methods, and their treatment approaches. We sent a survey with 32 questions to 152 corneal specialists, and 51 replied. Most thought long-term problems with the eye surface or surgery on the eye caused the condition. The most commonly used tests involved seeing if the pain reduces with numbing drops, checking for dry eye, and checking how sensitive the nerves at the front of the eye were. Only about a third used a special microscope test called in vivo confocal microscopy, but when it showed nerve problems, this often changed how they treat patients. Doctors most often used treatments like lubricants, blood-derived eye drops (i.e., serum or plasma), steroid drops, and cyclosporin drops. However, few felt confident prescribing oral medicines that affect the whole body to treat the eye pain. Almost half worked with other specialists to manage the condition, especially pain and brain doctors. These results show there are different ways to investigate and treat neuropathic corneal pain and highlight the need for clearer guidelines to help doctors care for people living with this painful condition.