What alternative treatments do you recommend trying for patients struggling with persistent, chronic ocular surface pain following refractive surgery unresponsive to traditional methods (i.e., lubrication, topical cyclosporine, punctal plugs)?

The first step is to identify the underlying cause of pain.

• If nociceptive: Target the visible source of pain.
• If peripheral neuropathic (e.g., due to corneal nerve abnormalities): Consider topical therapies that modulate nerve function, such as autologous blood-derived products (PRGF, AST, PRP) or insulin eye drops.
• If central/nociplastic: When pain persists despite anesthetic use or is accompanied by marked light sensitivity, consider systemic neuromodulators or other approaches.

Key takeawa...