Successful management of corneal neuropathic pain with intrathecal targeted drug delivery

Abstract

Objective. To describe the successful treatment of refractory corneal neuropathic pain with neuromodulation techniques. Design. Single case report. Setting. Academic tertiary care center in the United States of America. Subject and Methods. A 30-year-old woman presented with a 7-year history of refractory bilateral keratoneuralgia following laser-assisted in-situ keratomileusis (LASIK) procedure on both eyes. Having failed all conservative measures, the patient initially underwent trigeminal nerve stimulation and subsequently was implanted with an intrathecal drug delivery system (IDDS) with the catheter placed at the level C1. Results. Following an initial favorable response to the trigeminal nerve stimulator, the pain became refractory to neurostimulation after a few months and the system was explanted. The patient was successfully trialed with an intrathecal catheter placed at the level of C1 delivering a combination of bupivacaine and low dose fentanyl. The patient was then implanted with an IDDS equipped with a patient-activated bolus system. The patient was very satisfied with the treatment and has had greater than 50% pain relief for over a year. Conclusions. Intrathecal delivery of bupivacaine and low dose fentanyl in the upper cervical spine can be effective in controlling refractory eye pain in properly selected patients and treatment centers.