Autoimmune, Inflammatory Markers Associated with Neuropathic Corneal Pain

Researchers performed serological testing on 32 patients with neuropathic corneal pain after cataract surgery and found that 47% had neurological/psychiatric comorbidities. Photo: BBC.  Neuropathic corneal pain can develop after cataract surgery, but the etiology isn’t well known. Considering cataract surgery is one of the most common procedures, researchers in a recent study sought to identify serological markers that may stratify patients at a higher risk of developing neuropathic corneal pain post-cataract surgery and reduce the moderate impact on quality of life seen in these patients. They found an association with certain abnormal autoimmune markers and nutritional abnormalities, including high vitamin B6 and low vitamin B2. Their findings were presented Tuesday at the ARVO annual meeting in Salt Lake City.This retrospective cohort study included 32 patients with neuropathic corneal pain with reported pain onset after cataract surgery, most reporting pain immediately post-op but no later than six months. Systemic medical history, ocular history, prior surgical history, symptomatology, abnormal autoimmune or nutritional serology, clinical findings and pain impact on quality of life were studied. Patients were tested serologically for multiple autoimmune, dysimmune and inflammatory markers and metabolic abnormalities.The majority of the patients were female (75%), white (75%) and of non-Hispanic or Latino ethnicity (81.3%). Average pain measured on a visual analog scale of 0 to 10 was 4.8±2.7, with an average impact on quality of life of 4.9±2.6, measured by the Ocular Pain and Assessment Survey on a scale of 0 to 10.Neurological/psychiatric comorbidities were reported in 47% of patients. Among the 17 patients who had extensive serological testing, 70.6% had at least one abnormal autoimmune/dysimmune/inflammatory marker (41.2%, 14.3% and 25%, respectively) or a metabolic vitamin abnormality (64.3%). The most common positive markers were elevated anti-nuclear antibody (42.9%), anti-positive trisulfated heparin disaccharide antibody IgM (16.7%) and erythrocyte sedimentation rate (16.7%). Many of these patients also had high vitamin B6 (66.7%) and low vitamin B2 (21.4%).The most common impacts on quality of life were time spent thinking about pain and reading/computer use. The main symptoms reported were dryness (43.8%), light sensitivity (40.6%), burning (37.5%) and foreign body sensation (37.5%). “Understanding which markers are associated with a higher risk of developing neuropathic corneal pain after cataract surgery may alter their management and improve their quality of life,” the study authors concluded in their ARVO abstract.Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Mahjoub H, Bogen C, Hamrah P. Possible underlying etiologies in patients with neuropathic corneal pain after prior cataract surgery. ARVO 2025 annual meeting.