Corneal neuralgia and neurotrophic keratitis both involve the nerves on the surface of the eye, but they show up very differently for patients. Corneal neuralgia usually feels extremely painful even when the eye looks almost normal, while neurotrophic keratitis can quietly damage the cornea with little or no pain.
Corneal neuralgia (also called neuropathic corneal pain) happens when the nerves of the eye become overactive or “miswired.”
People often describe:
Burning or stinging
Sharp, stabbing, or aching pain
Extreme light sensitivity
Gritty or sandy feeling
Pain that seems far worse than what any eye doctor can see
Sometimes numbing drops at the office help only a little or not at all. This can be very frustrating and can make patients feel like “no one believes how bad it is.”
Corneal neuralgia can start after:
Eye surgery (like LASIK or cataract surgery)
Viral infections such as shingles or herpes in the eye
Long-standing dry eye disease
Nerve problems elsewhere in the body (like diabetic neuropathy)
Trauma or sometimes for no clear reason
Here, the nerves are over‑reacting to normal signals, similar to how an alarm system can keep going off even when nothing is wrong.
Neurotrophic keratitis is almost the opposite problem. Instead of being too sensitive, the corneal nerves become damaged and stop working well. The surface of the eye loses feeling and doesn’t heal normally.
Because the cornea is numb or reduced in feeling, patients may have:
Mild or even no pain
Blurry or fluctuating vision
Redness, irritation, or a “dry” feeling
A spot on the eye that just won’t heal
The big concern is that the cornea can develop non‑healing wounds, ulcers, thinning, and even a hole in the eye, sometimes without the severe pain you would expect.
Neurotrophic keratitis can be caused by:
Herpes or shingles involving the eye
Brain or facial surgery or trauma that affects the eye’s nerve supply
Long‑term use of certain eye drops
Diabetes or other health conditions that damage nerves
Long‑term contact lens wear or previous eye surgeries
Here, the nerves are not sending enough signals, so the eye doesn’t sense damage and doesn’t start the normal healing process.
| Question | Corneal neuralgia | Neurotrophic keratitis |
|---|---|---|
|
1) How do my eyes feel? |
Very painful, burning, light sensitive, often out of proportion to exam |
Surprisingly little pain; more “dry,” red, or blurry |
|
2) What does the doctor see? |
Eye may look almost normal or mildly dry | Surface damage, non‑healing spots, or ulcers |
|
3) What’s the main nerve problem? |
Nerves are overactive and oversensitive | Nerves are damaged and don’t feel normally |
|
4) Is my vision at risk? |
Quality of life can suffer; vision can be affected over time | Yes; can lead to scarring, thinning, or vision loss if not treated |
| 5) How urgent is it? | Important to treat, especially for pain and quality of life |
Can be an emergency in later stages; needs close follow‑up |
Our goal with corneal neuralgia is to calm the nerves, protect the surface, and support you as a whole person—not just your eyes.
Common parts of a treatment plan may include:
Lubricating the surface
Preservative‑free artificial tears, gels, and ointments
Treating eyelid oil glands (warm compresses, lid hygiene, in‑office treatments) to improve the tear film
Reducing surface inflammation
Short courses of prescription anti‑inflammatory drops
Longer‑term “immune‑calming” drops for chronic surface inflammation
Healing and nourishing the nerves
Special “biologic” tears, like autologous serum or platelet‑rich plasma, made from a small sample of your own blood
Amniotic membrane (a thin, natural bandage placed on the eye) in more severe cases
Treating nerve pain itself
Working with your primary doctor or a pain specialist on nerve‑targeted medications (for example, medications sometimes used for nerve pain, mood disorders or migraines)
Support for the emotional side of chronic pain—because persistent eye pain can affect sleep, mood, and daily life
Specialty lenses
Scleral lenses that vault over the cornea, bathing it in fluid all day; some patients experience significant relief, though not everyone can tolerate lenses
We customize the plan based on your symptoms, lifestyle, and how your eyes respond.
With neurotrophic keratitis, our priorities are to protect the eye, get the surface to heal, and—when possible—help nerves recover.
Common steps include:
Protecting and hydrating the eye
Frequent preservative‑free artificial tears and thicker nighttime ointments
Blocking the tear ducts with tiny plugs to keep your natural tears on the eye longer (punctal plugs like Lacrifill)
Stopping or switching any eye drops that may be toxic to the surface
Helping the surface heal
Protective contact lenses (bandage lenses) or scleral lenses to shield the cornea and keep it bathed in moisture
Biologic tears (like serum or platelet‑rich plasma) that bring natural growth factors to help the surface and nerves heal
Amniotic membrane such as Prokera or Cam360
Medications that target nerve healing
A prescription nerve growth factor drop (cenegermin/Oxervate) that is specifically designed to treat neurotrophic keratitis by supporting nerve and surface healing
Preventing infections and serious complications
Antibiotic drops when there are open defects or ulcers, to prevent infection
Careful use of anti‑inflammatory drops, if needed, with close monitoring
Neurotrophic keratitis can be vision‑threatening, especially in the later stages, so close follow‑up and early treatment make a big difference.
Consider seeing a dry eye and corneal specialist if:
Your “dry eye” is extremely painful, and multiple treatments haven’t helped.
Your eye doctor says your eyes “look fine,” but your pain is severe.
You have a stubborn, non‑healing spot or ulcer on the cornea.
You have a history of shingles/herpes in the eye, brain or facial surgery, diabetes, or other nerve issues and notice changes in how your eye feels.
In our dry eye center, we:
Check the sensitivity of your cornea
Use advanced imaging and testing to look deeply at the ocular surface.
Build a personalized plan that may include advanced drops, special lenses, biologic therapies, and coordination with other specialists.
If your eyes hurt far more than they “should,” or if your eye looks dangerously unhealthy but barely hurts at all, it could be more than routine dry eye. A focused evaluation for corneal neuralgia or neurotrophic keratitis can help protect both your comfort and your vision.