The structural effect of the RK incisions on this cornea is clearly visible in the OCT cross-section, where an incision appears on the right.
Like most patients we see with RK, the incisions remain open many years later, and in fact, never heal.
This patient is successfully wearing a GVR Scleral lens after having undergo 2 separate LASIK surgeries, 1 PRK and 1 TPK. Additional complications arose which forced the amputation of the corneal flap.
Conclusion: Patients with persistent dry eye symptoms out of proportion to clinical signs after LASIK have a syndrome that may best be classified as corneal neuralgia. In vivo confocal microscopy can be informative as to the neuropathic basis of this condition. In keeping with current understanding of complex regional pain syndrome, early multimodal treatment directed toward reducing peripheral nociceptive signaling is warranted to avoid subsequent centralization and persistence of pain. Distinguishing this syndrome from typical post-LASIK dry eye remains a challenge.