Validate chronic post-surgical eye pain, ophthalmologists told

Ophthalmologists must validate the experience of patients who report chronic post-surgical eye pain, according to Dr Conor Hearty, Consultant in Anaesthesia and Pain Medicine, the Mater Misericordiae University Hospital, Dublin.

Speaking on the management of neuropathic pain in ophthalmology at the Irish College of Ophthalmologists 2026 Annual Conference, Dr Hearty said persistent pain after apparently successful eye surgery can have a profound impact on patients’ quality-of-life, and create an increased risk of depression and suicidal ideation.

“Listening and validating the patient’s pain is a key part of treatment,” he stressed. “Never dismiss them.”

Chronic post-surgical pain is defined as pain that persists for more than three months after surgery. Patients with chronic post-surgical eye pain often report being told that “everything looks normal” or that their symptoms are due to anxiety, despite continuing pain.

Dr Hearty noted that the cornea contains the densest peripheral nerve network in the human body and that neuropathic mechanisms may contribute to symptoms even when clinical findings are minimal.

According to Dr Hearty, clinicians should acknowledge that while the surgical objective may have been achieved, persistent pain can still occur, and apply a structured pain medicine approach.

Certain patients are at higher risk of developing chronic post-operative pain, including those with a history of chronic pain, anxiety, depression, pain catastrophising, previous surgery, or poorly controlled acute post-operative pain.

More complex procedures, larger incisions, and repeat surgeries may also increase risk.

Identifying high-risk patients before surgery provides opportunities for prevention, including optimisation of acute pain management and, where appropriate, psychological interventions such as cognitive behavioural therapy.

Accurate diagnosis and classification of pain are also essential. Pain may be nociceptive, nociplastic, neuropathic, or mixed in nature, and treatment should be tailored accordingly.

Dry eye disease remains one of the most common causes of persistent post-surgical discomfort and should be assessed and treated proactively before more advanced interventions are considered.

The primary aim of treatment is restoration of function and quality-of-life rather than complete pain relief, he pointed out. Self-management, exercise, sleep hygiene, and psychological support all have important roles, while patients with refractory symptoms may require multidisciplinary care and referral to pain specialists.

Dr Hearty added that neuropathic pain medications may benefit selected patients.

However, he cautioned against opioid escalation, and noted the importance of individualised patient and drug risk assessments (for example, some medications can exacerbate dry eye and increase glaucoma risk).

“It is unusual for patients to have a poor pain-related outcome following corneal surgery, but when it happens, recognising it is key to treating it.”