**Background**
Corneal neuropathic pain (CNP) is a rare and debilitating condition characterized by corneal pain in the absence of a noxious stimulus. It causes a variety of ocular surface symptoms including foreign-body sensation, photophobia, burning, irritation, and epiphora, significantly impacting patients' quality of life and function. Despite research into its pathophysiology, there is limited understanding of the patient perspective. This article aims to improve understanding of how CNP affects patients and highlight areas of unmet need by providing insights from patient and physician interviews.
**Methods**
This article presents the patient and physician perspective on CNP based on interviews with patients and clinicians experienced in managing CNP. It does not include primary research by the authors. The article is based on previously conducted studies and does not contain any new studies with human participants or animals. Participants provided informed written consent.
**Key Results**
Two patient perspectives are presented. Patient 1 developed CNP after LASIK surgery in 2012, experiencing dryness, discomfort, and light sensitivity. Despite multiple treatments including artificial tears, warm compresses, punctal plugs, steroids, and Restasis, symptoms persisted. The patient was told their eyes looked 'pretty good' with 'minimal staining'. Eventually diagnosed with chronic neuropathic corneal pain, they were enrolled in a trial medication study and started on autologous serum drops, which provided noticeable improvement in burning pain after a few weeks. Patient 2, a 53-year-old man, had a history of PRK surgery, mild blepharitis, and later developed Bell's palsy in December 2015. Despite treatments including ciclosporin A, punctum plugs, IV methylprednisolone, botulinum toxin injections, autologous serum drops, and an amniotic membrane contact lens, symptoms worsened. He was diagnosed with ocular neuralgia in 2017 and had to take long-term sick leave. Both patients reported feeling ignored and that their symptoms were not taken seriously, with one specialist suggesting stress as an underlying cause. The physician perspective notes that CNP is often a diagnosis of exclusion, with no clearly defined diagnostic criteria. Symptoms vary but include burning, irritation, foreign-body sensation, and light sensitivity. The disparity between symptoms and signs leads to the term 'pain without stain'. Diagnosis relies on thorough medical history, ocular pain questionnaires (e.g., Ocular Pain Assessment Survey), and the proparacaine challenge test to distinguish peripheral from central sensitization. In vivo confocal microscopy can show tortuosity, microneuromas, and beading of corneal nerve fibers. Management is multimodal and multidisciplinary, including stabilization of the ocular surface, anti-inflammatory medication, management of comorbidities, and neuroregeneration. There is no cure, and treatment requires patience, trust, and commitment from both clinician and patient.
**Clinical Implications**
CNP is under-researched and significantly impacts quality of life. Diagnosis is challenging and often delayed, leading to severe symptoms at diagnosis and poor outcomes. Raising awareness and improving education for clinicians, allied health professionals, and patients should be a priority. Effective management requires a patient-centered, multidisciplinary approach, with validation of the patient's condition being crucial. The article emphasizes the need for further research to improve understanding and management of CNP.