title: Electrical Stimulation of the Trigeminal Ganglion and Intrathecal Drug Delivery Systems for the Management of Corneal Neuropathic Pain.
abstract: OBJECTIVE
  This case study reports on 2 novel neuromodulatory approaches in the management of a particularly recalcitrant case of corneal neuropathic pain.
  
  
  METHODS
  Report of a case
  
  
  RESULTS
  : A 32-year-old woman presented with intractable bilateral dry eye-like symptoms and corneal neuropathic pain after undergoing laser in situ keratomileusis surgery. Extensive ocular and systemic therapies were unsuccessful. Implantation of an electrode for the electrical stimulation of the trigeminal ganglion resulted in complete resolution of symptoms, but pain recurred after lead migration. Implantation of an intrathecal infusion system for fentanyl and bupivacaine delivery at the C1-C2 level resulted in control of her symptoms with excellent pain relief for more than 1 year.
  
  
  CONCLUSIONS
  Electrical stimulation of the trigeminal ganglion and a high cervical intrathecal pain pump can be used in the management of corneal neuropathic pain unresponsive to ocular and systemic approaches.
authors.affiliation: *Department of Ophthalmology, University Hospitals Eye Institute, Cleveland, OH; Departments of †Neurological Surgery; and ‡Anesthesiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Rony R
authors.initials: RR
authors.lastname: Sayegh
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sweet
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Miller
authors.forename: Salim M
authors.initials: SM
authors.lastname: Hayek
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003316:Corneal Diseases / Q000209:etiology / Q000628:therapy*; D016503:Drug Delivery Systems; D015352:Dry Eye Syndromes / Q000209:etiology / Q000628:therapy; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D058447:Eye Pain / Q000209:etiology / Q000628:therapy; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D060186:Infusions, Spinal; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects; D018613:Microscopy, Confocal; D012008:Recurrence; D012668:Trigeminal Ganglion / Q000502:physiology*; D014277:Trigeminal Neuralgia / Q000209:etiology / Q000628:therapy*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine