Refractive Surgery May Yield Chronic Pain, Neurological and Psychological Disorders

Patients with dry eye symptoms following refractive surgery may experience a reduced quality of life due to neurological and psychological factors.

Chronic ocular pain is common among patients seeking consultation for persistent dry eye (DE) following refractive surgery (RS), according to a study published in The Ocular Surface. Neurological and psychiatric disorders,  along with central sensitization syndromes were also more frequent following these surgeries than before the procedures.  

Researchers enrolled 104 patients (67% women, mean age, 39.5 ± 9.5 years) who developed persistent DE symptoms and chronic ocular pain after undergoing RS in a cross-sectional, observational, single-visit study. Participants underwent a comprehensive exam and completed the ocular surface disease index (OSDI), modified single item dry eye questionnaire (mSIDEQ), numerical rating scale (NRS), and hospital anxiety and depression scale (HADS) questionnaires. Tear stability, ocular surface integrity, corneal tactile sensitivity, and anesthetic challenge tests were also assessed.

[Dry eye] symptoms have a large negative impact on the quality of life, especially if accompanied by neuropathic pain. Thus, patients with severe [dry eye] are more likely to experience psychological stress, depression, and/or anxiety.

A total of 85.6% of patients had corneal RS and 75.3% underwent laser-assisted in situ keratomileusis (LASIK). The remaining 14.4% had intraocular RS, which most often included lens phacoemulsification and multifocal intraocular lens implantation. 

Overall, neurological disorders (4.8% to 51.9%; P <.0001), psychiatric disorders (2.8% to 32.7%; P <.0001), and central sensitization syndromes (4.8% to 15.4%; P =.0214) increased following RS. Persistent DE symptoms, reported as severe in 86.5% patients, developed within 0 to 204 months following RS. 

Tear osmolarity (315.2±17.1 mOsm/L; normal ≤308) and tear break-up time (4.1±2.5 s; normal >7) were the only DE-related clinical assessments showing abnormal values.

Baseline corneal sensitivity (55.4±7.0 mm) decreased following topical anesthesia, (6.0±10.4 mm; P <.0001), but remained pathologically elevated, (≥10 mm) in 58.7% patients. Normal symptomatic post-anesthesia improvement was absent in 58 (55.7%) patients, according to the report. 

Subjective assessments yielded scores of 60.7±22.7, 18.6±4.9, 6.9±2.4, and 18.9±9.6 for the OSDI, mSIDEQ, NRS, and HADS, respectively.  

“DE symptoms have a large negative impact on the quality of life, especially if accompanied by neuropathic pain,” according to the researchers. “Thus, patients with severe DE are more likely to experience psychological stress, depression, and/or anxiety.”

Study limitations include potential recall bias, a possible overlap in patients with neuropathic and nociceptive pain, and the failure to perform Belmonte’s gas esthesiometry and in vivo confocal microscopy of the corneal nerve plexus.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or clinical research organizations. Please see the original reference for a full list of authors’ disclosures. 


Vázquez A, Martínez-Plaza E, Fernández I, et al. Phenotypic characterization of patients developing chronic dry eye and pain after refractive surgery: a cross-sectional study. Ocul Surf. 2022;26:63-74. doi:10.1016/j.jtos.2022.07.010.