Stylized eye with a crack on cornea, symbolizing risk of ulcer after eye surgery.

Vision SOS: Could Your Cataract Surgery Be Hiding a Silent Threat?

Jordan Keane in Health & Wellness November 2025 • 4 min read.

"Unveiling the Link Between Limbal Relaxing Incisions and Neurotrophic Corneal Ulcers"

Cataract surgery is a marvel of modern medicine, restoring sight to millions each year. As techniques evolve, procedures like limbal relaxing incisions (LRIs) have become popular for correcting astigmatism during cataract surgery, aiming to provide even sharper vision. However, like any surgical intervention, it's essential to understand the potential risks involved.

One rare but serious complication that can arise post-cataract surgery, particularly when combined with LRI, is the development of a neurotrophic corneal ulcer. This condition stems from a loss of corneal sensation, which can impair the cornea's ability to heal and defend itself against damage. While neurotrophic keratitis has various causes, including herpes virus infections, it can also occur following cataract surgery.

In this article, we'll explore a case study that highlights the connection between cataract surgery involving LRI and the subsequent development of a neurotrophic corneal ulcer. We'll delve into the risk factors, symptoms, treatment approaches, and preventive measures you can take to ensure the best possible outcome for your vision.

What is the link between Limbal Relaxing Incisions and Corneal Ulcers?

Stylized eye with a crack on cornea, symbolizing risk of ulcer after eye surgery.

To understand the link, it's helpful to first understand what a limbal relaxing incision is. An LRI is a small incision made at the limbus (the border between the cornea and the sclera) to reduce corneal astigmatism. Astigmatism occurs when the cornea is irregularly shaped, causing blurry or distorted vision. By carefully creating these incisions, surgeons can reshape the cornea to improve focus.

The cornea is densely innervated with sensory nerves that are vital for maintaining its health. These nerves signal the need for lubrication, blink reflexes to remove irritants, and trigger the healing process when an injury occurs. Cataract surgery, particularly when combined with LRI, can potentially damage these corneal nerves, leading to corneal hypoesthesia (reduced sensation).

Nerve Damage: The act of making incisions, especially LRIs, can disrupt the corneal nerve network.
Reduced Sensation: This nerve damage can lead to reduced corneal sensitivity, meaning the eye is less aware of injuries or dryness.
Impaired Healing: Reduced sensation impairs the natural healing processes of the cornea, making it vulnerable to developing ulcers.
Increased Risk: Patients with pre-existing conditions, such as diabetes, herpes infections, or dry eye, are at higher risk.

A case study highlighted in the Korean Journal of Ophthalmology detailed a 60-year-old man who underwent cataract surgery with LRI and subsequently developed a neurotrophic corneal ulcer. The patient had pre-existing conditions, including lower lid ectropion and lagophthalmos (inability to close the eyelids completely), which increased his risk of corneal issues. The ulcer developed at the site of a pre-existing corneal opacity near the limbal relaxing incision.

Protecting Your Vision: What You Need to Know

While the development of a neurotrophic corneal ulcer after cataract surgery with LRI is rare, it's essential to be aware of the risks and take proactive steps to protect your vision. If you're considering cataract surgery, discuss your individual risk factors with your ophthalmologist. Be sure to mention any pre-existing conditions such as dry eye, diabetes, herpes infections, or any history of corneal problems. Don't hesitate to ask questions about the benefits and risks of LRI versus other astigmatism correction methods like toric intraocular lenses.

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.

This article is based on research published under:

DOI-LINK: 10.3341/kjo.2011.25.3.210, Alternate LINK

Title: Neurotrophic Corneal Ulcer Development Following Cataract Surgery With A Limbal Relaxing Incision

Subject: General Medicine

Journal: Korean Journal of Ophthalmology

Publisher: Korean Ophthalmological Society

Authors: Sang-Woong Moon, Dong-Ju Yeom, So-Hyang Chung

Published: 2011-01-01

Everything You Need To Know

What is a Limbal Relaxing Incision (LRI) and why is it used during cataract surgery?

A Limbal Relaxing Incision (LRI) is a small incision made at the limbus, the border between the cornea and the sclera. Surgeons use LRIs during cataract surgery to correct astigmatism. Astigmatism occurs when the cornea has an irregular shape, causing blurred or distorted vision. LRIs reshape the cornea, improving focus and aiming for sharper vision for the patient.

What is a neurotrophic corneal ulcer, and how does it relate to cataract surgery and Limbal Relaxing Incisions?

A neurotrophic corneal ulcer is a serious condition that arises from a loss of corneal sensation. This loss impairs the cornea's ability to heal and defend itself. In the context of cataract surgery, particularly when combined with Limbal Relaxing Incisions (LRIs), the risk of developing this ulcer increases. The incisions can potentially damage corneal nerves, leading to reduced sensation (corneal hypoesthesia). This nerve damage impairs the cornea's natural healing processes, making it more vulnerable to ulcer development. The article highlights this connection, emphasizing the importance of understanding the risks.

What are the potential risk factors that might increase the chances of developing a neurotrophic corneal ulcer after cataract surgery with LRI?

Several factors can elevate the risk. The act of making incisions, especially Limbal Relaxing Incisions (LRIs), can disrupt the corneal nerve network. Additionally, pre-existing conditions such as diabetes, herpes infections, and dry eye can increase the risk. The case study mentioned pre-existing conditions like lower lid ectropion and lagophthalmos, which further increased the patient's vulnerability to corneal issues after the surgery. The loss of corneal sensation, either due to nerve damage from the surgery or pre-existing conditions, is the critical factor.

How can cataract surgery, specifically with Limbal Relaxing Incisions, lead to nerve damage in the cornea?

The cornea is densely innervated with sensory nerves crucial for its health. These nerves are responsible for triggering the blink reflex, which removes irritants, and initiate the healing process after an injury. When a surgeon performs a Limbal Relaxing Incision (LRI), this process involves making incisions in the cornea. These incisions can directly disrupt the delicate corneal nerve network. Consequently, this damage can lead to reduced corneal sensitivity (hypoesthesia), impairing the eye's ability to detect injuries or dryness and hindering the normal healing process. This is a direct effect of the surgical procedure on the corneal nerves.

What steps can I take to protect my vision if I am considering cataract surgery, and what should I discuss with my ophthalmologist regarding Limbal Relaxing Incisions and potential risks?

If you're considering cataract surgery, the most important step is to discuss your individual risk factors with your ophthalmologist. Be sure to mention any pre-existing conditions like dry eye, diabetes, herpes infections, or a history of corneal problems. It is important to ask your ophthalmologist about the benefits and risks of Limbal Relaxing Incisions (LRIs) compared to other astigmatism correction methods, such as toric intraocular lenses. Understanding the potential for nerve damage, reduced corneal sensation, and the possibility of developing a neurotrophic corneal ulcer is vital. Openly discussing these points allows you to make an informed decision and take proactive measures to protect your vision after surgery.