Laser-assisted refractive surgery (LASIK) is widely used to correct vision and reduce reliance on glasses or contact lenses. Many patients recover quickly and achieve clarity of vision. However, over recent years, clinicians have raised concern about a serious complication: corneal neuralgia (also called neuropathic corneal pain, NCP), persistent, often debilitating eye pain that does not respond to standard dry-eye treatment and can severely impair quality of life.
In a recent Instagram reel, Dr. Julian Prosia, a board-certified Optometrist and dry eye specialist, stated that while earlier estimates of post-LASIK neuralgia hovered around 1 %, recent studies from 2025 show incidence rates of 10 % to 15 % among LASIK patients experiencing neuralgia and severe dry eye symptoms.
He emphasized that the surgical trauma to corneal nerves during LASIK flap creation and ablation may underlie this trend.
Neuropathic corneal pain (NCP) is a condition in which the corneal nerves become hypersensitized or damaged, causing patients to feel pain in response to stimuli that normally would not cause discomfort. Symptoms may include burning, shooting pain, photophobia (light sensitivity), and continuous ocular discomfort. Crucially, patients often report pain that is out of proportion to clinical exam findings, for example, minimal corneal staining or tear dysfunction. 2
A 2025 study comparing patients with NCP versus conventional dry eye disease (DED) found that those with neuropathic pain reported worse pain severity, more negative impact on quality of life, and greater sensitivity to mechanical or chemical stimuli.
Interestingly, these patients often had less corneal surface damage on objective evaluation, reinforcing the idea that NCP is not simply worse dry eye but a distinct pain syndrome. 1
Because of overlap with dry eye symptoms, NCP is frequently misdiagnosed as refractory dry eye, delaying proper treatment.
Recent prospective cohorts and retrospective studies have started to quantify how often NCP occurs after LASIK and similar refractive procedures.
A 2025 prospective cohort study of LASIK and SMILE patients reported NCP incidence of 10.5 % after LASIK and 13.3 % after SMILE (small-incision lenticule extraction). Factors associated with NCP included lower preoperative corneal nerve fiber length and density, higher nerve width, and neuroma formation. 5
A comparative study on corneal sensory changes found that eyes developing both dry eye and neuropathic ocular pain post-LASIK had more marked nerve plexus alterations on in vivo confocal microscopy than eyes with only dry eye. 4
These findings support the hypothesis that nerve injury during LASIK (especially in flap creation and stromal ablation) plays a key role in pathogenesis. After nerve injury, aberrant nerve regeneration may lead to central sensitization—a state in which the nervous system amplifies pain signals, sustaining chronic pain. 2
Dry eye disease (DED) is well recognized as a common post-LASIK complication. Studies suggest that up to 60 % of patients may experience some degree of dry eye in the early postoperative period which corrects itself in a short duration.
While many recover as the ocular surface heals, in some cases ongoing tear film instability and epithelial stress can aggravate nerve irritation. In susceptible individuals, this may evolve into neuropathic pain. Indeed, a review on post-LASIK dry eye suggests that unmanaged surface disease may predispose to more severe outcomes. 3
Clinically, when patients report persistent pain despite aggressive dry eye therapy—and when pain is greater than signs would suggest—clinicians are advised to consider NCP in the differential diagnosis.2
Diagnosing NCP is challenging because there is no definitive biomarker, and signs may be minimal.
Because NCP overlaps symptomatically with DED but diverges in its neural mechanisms, treatment often requires multimodal approaches combining ocular surface therapy with analgesics, neuromodulators, or specialized pain management. 2
While the majority of LASIK patients do not develop long-term neuralgia, the possibility of NCP is now receiving more attention. The raised incidence estimates—10 % or more in some studies—warrant careful preoperative screening, patient counseling, and postoperative monitoring.
Key considerations for patients and providers:
Patients with preexisting dry eye, ocular surface disease, or nerve sensitivity may be at higher risk
Surgeons may need to evaluate nerve status preoperatively (e.g. via confocal imaging)
Informed consent should include discussion of rare but potentially serious neuralgia risk
Early recognition and referral for pain management are crucial when symptoms persist beyond the typical recovery period
References
Labbe, Anne, et al. “Quality of Life and Symptomatology in Patients With Neuropathic Corneal Pain.” Cornea 44, no. 7 (2025): 987–995. https://journals.lww.com/corneajrnl/fulltext/2025/07000/quality_of_life_and_symptomatology_in_neuropathic.4.aspx.
Aggarwal, Shalini, et al. “Neuropathic Corneal Pain After Refractive Surgery: Pathophysiology and Management.” Eye 39 (2025): 1120–1132. https://www.nature.com/articles/s41433-024-03060-x.
Rosenthal, Peter, and Anat Galor. “Management of Chronic Neuropathic Ocular Pain.” Frontiers in Medicine 10 (2023): 1057685. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1057685/full.
Epitropoulos, Athanasios T., et al. “Corneal Nerve Changes and Neuropathic Pain After LASIK and SMILE Surgery.” American Journal of Ophthalmology 240 (2023): 45–56. https://www.ajo.com/article/S0002-9394(25)00172-2/fulltext.
Teo, Calesta Hui Yi, Chang Liu, Isabelle Xin Yu Lee, Molly Tzu-Yu Lin, Fengyi Liu, Charmaine Jan Li Toh, Siew Kwan Koh, Da Qian Lu, Thomas Chuen Lam, Lei Zhou, Louis Tong, Jodhbir S. Mehta, and Yu-Chi Liu. "Neuropathic Corneal Pain Following Refractive Surgery: Risk Factors, Clinical Manifestations, Imaging and Proteomic Characteristics." British Journal of Ophthalmology 109, no. 7 (2025): 747–755. https://doi.org/10.1136/bjo-2024-325996
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