This is a photo of me with my very special patient, Captain Juan Fernandez, United States Marine Corp (Retired). Captain Fernandez served 2 tours of duty in Iraq and Afghanistan while suffering ocular pain due to a severe case of keratoconus in both eyes. During the last few years of his service in the military, Captain Fernandez’ ocular condition worsened. In order to function while serving overseas, he wore “piggy back” lenses, that is soft lenses on his corneas with hard lenses over the soft lenses. Captain Fernandez told me that with these lenses he was always in pain. It was very difficult for him to keep his eyes open and he was always extremely light sensitive. Prior to retiring from the Marine Corp. Captain Fernandez entered the “Wounded Warrior Battalion” and was placed on the corneal transplant wait list. Before being placed on this wait list, Captain Fernandez had Intacs surgery in both eyes. The Intacs did not improve his vision or reduce his eye pain. While waiting for the corneal transplant, Captain Fernandez told me that due to the severity of the eye pain and light sensitivity he was forced to live in virtual darkness for 2 years. 2 weeks prior to his scheduled visit for corneal transplant surgery, Captain Fernandez visited our office in 2011. At this visit we fit Captain Fernandez with GVR Scleral lenses. After receiving his scleral lenses, Captain Fernandez was able to see clearly (20/20) and comfortably once again for the first time in many years. Today, Captain Fernandez told me that when he walked out of my office for the first time with his scleral lenses he noted an ant of the ground and dew on a tree and was able to see for the first time in 2 years his children’s faces. Captain Fernandez’ eyes and vision have remained clear and stable for the last 5 years. He is no longer in pain and has no light sensitivity with his lenses on. He will never need to undergo corneal transplant surgery. Helping Captain Fernandez see clearly and comfortably once again has been one of the highlights of my professional career.

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.

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