Patient Questionnaires

Anonymous participation. No personal data is collected. Each response is linked only through a random ID for research consistency.

🟢 Completed 🔴 Not completed

1. Disease Cause & Onset

Suspected cause of corneal neuralgia (you can select multiple) Did symptoms begin suddenly or gradually?

2. Pain

How is pain distributed between your eyes?

Left eye 50% Balanced Right eye 50%

What kind of pain do you have? Do you have trigeminal involvement (facial pain like jaw, cheeks, ear, forehead, back of the head, ...)? Pain immediately upon waking? Pain worsens during the day? Pain occurs during sleep?

3. Light Sensitivity

Are you screen sensitive? That includes TV, phone, computer, LED lights, ... Are you sunlight sensitive? Ignore outdoor factors - how does sun feel through the window from a safe environment?

4. Visual Disturbances

Do you experience visual problems like HOA (Higher-Order Aberrations), such as blurry vision, starbursts, etc...?

5. Environmental Triggers

Wind triggers pain? Air conditioning triggers pain? Outside air triggers pain? Do airtight goggles help? Do less tight goggles (Ziena etc.) help? Heat / warm compresses worsen pain? Hot shower steam reduces pain temporarily? Ice packs help? Clicking sounds when blinking?

7. Mental Health

Do you have any past psychiatric history prior to the onset of eye problems? On a scale from 1 to 10 (1 = not at all, 10 = extremely), how would you rate your depression after the onset of eye problems? On a scale from 1 to 10 (1 = not at all, 10 = extremely), how would you rate your anxiety after the onset of eye problems? Since onset of eye problems, have you experienced suicidal thoughts? Since the onset of eye problems, have you experienced any self-harming behaviors?

9. Systemic Treatments Help

Gabapentin / Pregabalin helped? Carbamazepine / Oxcarbazepine helped? Amitriptyline / Nortriptyline helped? Duloxetine helped? Opioids helped? Low Dose Naltrexone (LDN) oral helped? Benzodiazepine helped? THC helped? Ketamine helped? Psilocybin mushrooms (magic mushrooms) helped?

10. Ocular Treatments Tried

Steroid drops reduce pain? Autologous Serum Tears (AST) help? Cyclosporine helps? Insulin help? Low Dose Naltrexone (LDN) eye drops help? Fosaprepitant eye drops help? Scleral lenses help?

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Patient Questionnaires

Beginning

Pain

Light Sensitivity

Visual Disturbances

Environmental Triggers

Eye Testing

Mental Health

Systemic Treatments

Ocular Treatments

Confocal Findings

1. Disease Cause & Onset

2. Pain

Left eye

Right eye

3. Light Sensitivity

4. Visual Disturbances

5. Environmental Triggers

6. Eye Testing

Left Eye 👁️

Right Eye 👁️

7. Mental Health

8. Mechanical Sensitivity

9. Systemic Treatments Help

10. Ocular Treatments Tried

11. Special Observations

12. Confocal Findings