Painful or neuropathic dry eye disease
If you have pain in your eyes, you need to come in for an examination. After a complete evaluation to check for other serious eye conditions like glaucoma, I (Dr. Pradhan) might tell you that you have dry eye disease. If you may have pain that is relieved with topical numbing medication in clinic or if you have severe light sensitivity, you could have abnormal corneal nerves. One of the additions to the definition of dry eye disease in the DEWS II report was to add neuropathy or pain to the definition.
Chronic dry eye disease can lead to damage of your corneal nerves. Chronic dry eye changes the feedback loop of the surface of your eye. If you have had any eye surgery, it can also cause painful dry eye disease. Certain eye surgery actually cuts the corneal nerves (like LASIK) and depending on the location of the surgery and your body’s healing response, the corneal nerves may not grow back or they may grow back abnormally, leading to painful dry eye disease or painful light sensitivity. The treatment not only involves treating the surface dry eye disease but helping treat the source of the pain and light sensitivity. Thankfully, a few treatment options have been shown to help regrow corneal nerves over time (via in-vivo confocal microscopy) and help treat the pain from dry eye disease.
One of these effective treatment is autologous serum drops. These are tears made out of your own blood. This treatment and the regrowth of your corneal nerves also helps reset the feedback loop for your body to produce more tears and decrease pain and light sensitivity over the course of treatment, which can range from 6 months to 2 years depending on the severity of your symptoms. Autologous serum drops have even been used in other causes of dry eye disease including graft-vs-host (GVHD) or chemical burns to the eyes. I (Dr. Pradhan) offer my painful dry eye patients the options which help regrow corneal nerves effectively. These include autologous serum tears, amniotic membrane graft (like Prokera) and sometimes topical medications like cyclosporine 0.05% (Restasis). Depending on the severity of your condition, you may need a combination of these treatment options.
Here’s a recent case published in the Ophthalmology Times newsletter which highlights a patient with painful dry eye disease and his treatment.
Neuropathic dry eye: When serum defeats tears by By Melina I. Morkin MD, Pedram Hamrah MD FACS
I searched the medical literature website (Pubmed.gov) for autologous serum eye drops this morning and got 198 responses/articles so there is plenty of research supporting the use of autologous serum drops on the surface of the eye.
Autologous serum drops:
Autologous serum drops can be formulated at any concentration but typically start at 20% concentration and can be increased if needed over time.
Once you instill them, you will want to keep your eyes closed for 3 minutes. They are thick and can blur your vision for upto 5 minutes after instillation.
Since they are a blood product, they need to refrigerated or frozen at all times.
No one else can use them except the patient from whose blood they are made.
They have growth factors, immunoglobulins and vitamins which are not present in normal tears which can help heal your dry eye disease.
We are fortunate in Richmond to have a local compounding pharmacy which can make autologous serum drops for you. I (Dr. Pradhan) or my staff will draw your blood and the compounding pharmacy takes it from there to make your autologous serum drops and deliver them to your house usually within 2-3 days.
There is hope for painful dry eye disease. Thanks for reading.