Ocular pain persists for some patients after refractive surgery

Nearly one in 10 patients report persistent ocular pain after refractive surgery, according to a study, noting several pre- and perioperative factors that can predict pain following the procedure.

A total of 109 individuals undergoing refractive surgery at two different centres were included. Of these, 87 percent underwent laser-assisted in situ keratomileusis (LASIK) and 13 percent had photorefractive keratectomy (PRK). Patients rated ocular pain on a numerical rating scale (MRS) of 0 to 10 before surgery and 1 day, 3 months, and 6 months after surgery.

The investigators performed a clinical examination on ocular surface health at 3 and 6 months following surgery. Persistent ocular pain referred to an NRS score of 3 or more at both periods after the procedure. Patients were then compared with individuals with NRS scores of <3 at the same time points (controls).

Of the participants (mean age 34 years), 62 percent self-identified as female, 81 percent as White, and 33 percent as Hispanic. Eight patients (7 percent) reported ocular pain prior to surgery, with the frequency increasing after surgery to 23 percent (n=25) at 3 months and 24 percent (n=26) at 6 months.

Twelve patients (11 percent) reported an NRS score of ≥3 at both time points and constituted the persistent pain group.

Multivariable analysis revealed the following factors associated with persistent pain after surgery: ocular pain before the procedure (odds ratio [OR], 1.87, 95 percent confidence interval [CI], 1.06‒3.31), symptom report of depression before surgery (Patient Health Questionnaire-9: OR, 1.3, 95 percent CI, 1.1‒1.6; p=0.01), use of an oral antiallergy medication before surgery (OR, 13.6, 95 percent CI, 2.1‒89.3; p=0.007), and pain intensity day 1 after surgery (OR, 1.6, 95 percent CI, 1.2‒2.2; p=0.005).

No significant relationship was observed between ocular surface of tear dysfunction and ocular pain (p>0.05 for all ocular surface signs). In addition, majority of the patients (>90 percent) were completely or somewhat satisfied with their vision at 3 and 6 months.