Illustration of an eye with a subtle crack on the cornea, symbolizing vulnerability after surgery.

Cataract Surgery Complications: What You Need to Know About Corneal Ulcers

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Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Learn how limbal relaxing incisions during cataract surgery can sometimes lead to neurotrophic corneal ulcers and what precautions to take."


Cataract surgery is a widely performed procedure aimed at restoring clear vision by replacing a clouded natural lens with an artificial one. Modern cataract surgery often incorporates techniques to address astigmatism, a common refractive error that causes blurred vision. One such technique involves limbal relaxing incisions (LRIs), small cuts made at the edge of the cornea to reshape it and reduce astigmatism.

While LRIs are generally considered safe and effective, potential complications can arise. One rare but serious complication is the development of a neurotrophic corneal ulcer, which occurs when the cornea loses sensation and is unable to heal properly. This article explores a case study that highlights the link between cataract surgery with LRIs and the subsequent development of a neurotrophic corneal ulcer. We'll delve into the risk factors, preventative measures, and treatment options associated with this condition.

Understanding the potential risks and benefits of cataract surgery with LRIs is crucial for both patients and surgeons. By raising awareness of the possible complications and implementing appropriate precautions, we can work towards ensuring safer and more successful outcomes for all.

The Case: Neurotrophic Keratitis After Cataract Surgery

Illustration of an eye with a subtle crack on the cornea, symbolizing vulnerability after surgery.

A 60-year-old man underwent cataract surgery in his left eye. The procedure involved a 3mm clear corneal incision and a limbal relaxing incision (LRI) to correct pre-existing astigmatism. The LRI was created opposite the corneal incision, with a 70-degree arc width and a depth of 0.5mm along the keratometric steep axis. The patient had a history of bilateral conjunctivitis and right facial nerve palsy. He also exhibited lower lid ectropion and lagophthalmos in both eyes – conditions where the eyelid turns outward and the eye cannot fully close, respectively.

Eleven days following the surgery, the patient experienced abrupt-onset ocular pain. A slit-lamp examination revealed a neurotrophic corneal ulcer, characterized by a punch-out epithelial defect (1.5 x 1.5 mm) with hazy edges and stromal edema. The location of the ulcer was near the limbal relaxing incision, and the patient's best-corrected visual acuity (BCVA) was 20/200. The patient was diagnosed with clinical stage 2 neurotrophic keratitis.

  • Initial Treatment: The patient was treated with preservative-free sodium hyaluronate, topical levofloxacin, autologous serum, and oral doxycycline.
  • Laboratory Results: Confirmed no bacterial growth, and serological tests ruled out collagen vascular disease.
  • Corneal Sensitivity: A corneal sensitivity test showed decreased sensation in the inferior and infero-temporal regions.
  • Improvement and Healing: Six weeks post-surgery, corneal sensation improved. The neurotrophic corneal ulcer healed over the course of one year.
This case illustrates a rare but significant complication following cataract surgery with LRI. The presence of pre-existing conditions like ectropion, lagophthalmos, and a history of conjunctivitis likely contributed to the development of the neurotrophic ulcer. The limbal relaxing incision, intended to improve vision, may have inadvertently compromised corneal nerve function, leading to impaired healing and ulcer formation.

Protecting Your Vision: Precautions and Future Directions

While limbal relaxing incisions can be a valuable tool in correcting astigmatism during cataract surgery, it's crucial to exercise caution, especially in patients with pre-existing risk factors for corneal hypesthesia. Measuring corneal sensation before surgery can help identify individuals at higher risk. Alternative methods of astigmatism correction, such as toric intraocular lens insertion, may be more appropriate for certain patients. Further research is needed to optimize surgical techniques and minimize the risk of neurotrophic corneal ulcers, ensuring the best possible outcomes for patients undergoing cataract surgery.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is the primary purpose of limbal relaxing incisions (LRIs) during cataract surgery?

Limbal relaxing incisions (LRIs) are used in cataract surgery to correct astigmatism. These small cuts made at the edge of the cornea reshape it, thereby reducing the blurred vision caused by astigmatism. This is a common refractive error that often accompanies cataracts, making LRIs a useful technique for improving overall vision after cataract surgery.

2

What is a neurotrophic corneal ulcer, and how is it related to limbal relaxing incisions?

A neurotrophic corneal ulcer is a serious complication where the cornea loses sensation and is unable to heal properly. The use of limbal relaxing incisions (LRIs) can, in rare cases, lead to this condition. LRIs, while designed to improve vision, can potentially affect corneal nerve function, impairing the cornea's ability to heal and increasing the risk of ulcer formation. The case study highlights how an LRI might have contributed to the development of a neurotrophic corneal ulcer in a patient.

3

In the case study, what pre-existing conditions might have increased the risk of developing a neurotrophic corneal ulcer after cataract surgery with limbal relaxing incision?

In the described case, the patient had several pre-existing conditions that likely increased the risk. These included bilateral conjunctivitis, right facial nerve palsy, ectropion (outward turning of the eyelid), and lagophthalmos (inability to fully close the eye). These conditions could have compromised the protective mechanisms of the eye, making the cornea more vulnerable and less able to heal after the limbal relaxing incision (LRI).

4

What steps were taken to treat the neurotrophic corneal ulcer in the case study, and what was the outcome?

The patient was initially treated with preservative-free sodium hyaluronate, topical levofloxacin, autologous serum, and oral doxycycline. Laboratory tests confirmed no bacterial growth and ruled out collagen vascular disease. The corneal sensitivity test showed decreased sensation, which improved over time. The neurotrophic corneal ulcer healed completely over one year, and the patient's corneal sensation improved.

5

Besides limbal relaxing incisions, are there alternative methods to address astigmatism during cataract surgery, and when might these be more appropriate?

Yes, one alternative to limbal relaxing incisions for correcting astigmatism during cataract surgery is the insertion of a toric intraocular lens. This approach may be more appropriate for patients who have pre-existing risk factors for corneal hypesthesia (reduced corneal sensation). These individuals might be at higher risk for neurotrophic corneal ulcers, making the toric intraocular lens a safer option. Assessing corneal sensation before surgery can help identify these higher-risk patients and guide the choice of surgical technique.

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