New Treatment Option for Corneal Neuralgia

Many of my patients have an underlying corneal neuralgia in addition to or instead of meibomian gland dysfunction, aqueous or mucin deficiency/dry eye disease. There are many options that have helped these patients, such as autologous serum, PRP, amniotic membrane, Prokera, cord blood serum, Autologous stem cells, and strong pills, such as Naltrexone, LDN, steroids, pain pills. Still some patients can not tolerate pills or Prokeras and an alternative is desirable. 

In such patients some MDs have started trying Topical  Naltrexone 0.4 mg/ml as an “off-label, non FDA approved” drop, starting at 4times a day. 

Sometimes after a month or two patients feel better, and can be tapered to 3x/day for a few months, then 2x/day for a few months, then 1x/day as maintenance therapy.  An MD who has now used this on multiple patients estimates 70% of treated patients have found relief with minimal if any side effects. 

I will begin prescribing this but would like to follow patients endothelial cell counts and meibography scores to be sure there is no effect on these cells. 

Ideally we will receive a much needed grant to obtain a confocal microscopy to see topical Naltrexone’s effect on corneal nerve cells. If anyone wants to help us with funding for a confocal please email Sheyda:

Thank you to a special dry eye patient who found this new treatment option that may help others. 

Sandra Lora Cremers, MD, FACS 

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