Trigeminal Neuralgia and Retinal Detachment Repair

I had a retinal detachment in the right eye that was repaired with a scleral buckle in Feb 2010. I started experiencing constant throbbing and stabbing pain in the right eye and into the bridge of my nose within a month after the surgery.  The pain radiated out to my right temple and up to the top right side of my head, causing severe headaches. My attempt to go back to work in July 2010 ended with the eye pain being severely exacerbated with the extensive reading and computer work required for my job.  I unfortunately had to go on long term disability. My retina surgeon thought that perhaps the buckle was exerting pressure on the ocular nerves and recommended removing the buckle.  The removal surgery was performed in Sept 2010.  Unfortunately, my eye pain worsened and I began having tingling sensations in my head and right side of my face and stabbing pains on the right side of my face.  Sometimes the eye pain migrated to the left eye. I also began having severe pain while chewing and throbbing upper gums.  My retina surgeon first referred me to a neurologist, who thought it was atypical facial pain/trigeminal neuralgia. I later confirmed this diagnosis with with a neuro ophthalmologist at Univ of Pennsylvania.  He said this is rare but he does have 2-3 patients who have experienced this same situation.  I had severe side effects from the neuralgic meds that were prescribed and had to discontinue them.  The neuro ophthalmologist suggest Klonopin, but my gastroenterologist says this will aggravate my gastric reflux condition ( I am currently under treatment because the Cymbalta severely aggravated my reflux and I was experiencing gastritis symptoms along with the reflux symptoms).  I was told this is rare. But I was wondering if there is any literature on this? I would like to learn more about this.      

[Houman Vosoghi, MD]

This is a very specific question regarding a very rare condition.  I would suggest doing as much research on the subject as possible by using google to search for "emedicine trigeminal neuralgia" and also read through some abstracts at pubmed.org searching for articles related to treatment of trigeminal neuralgia.  This is beyond most ophthalmologists' scope of knowledge (especially with the gastritis affecting which medications you can take).

HV