Online Articles: Case ReportsAcquired Corneal Neuropathy and Photoallodynia Associated With Malposition of an Ex-PRESS ShuntBirnbaum, Faith A. BS*; Hamrah, Pedram MD†; Jacobs, Deborah S. MD‡; Song, Brian J. MD‡Author Information *Warren Alpert Medical School of Brown University, Providence, RI †Department of Ophthalmology, New England Eye Center/Tufts Medical Center, Tufts University School of Medicine ‡Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA Disclosure: The authors declare no conflict of interest. Reprints: Brian J. Song, MD, 243 Charles Street, Boston, MA 02114 (e-mail: [email protected]). Journal of Glaucoma: January 2017 - Volume 26 - Issue 1 - p e19-e21 doi: 10.1097/IJG.0000000000000502 Buy Metrics Abstract Purpose: Corneal neuropathy is a recently described disease process that is not well understood and is likely underdiagnosed as a result. This is the first reported case of an acquired corneal neuropathy associated with malposition of an Ex-PRESS shunt. Methods: A single case report. Results: We report the case of a 50-year-old man with a history of multiple procedures for glaucoma who subsequently developed photoallodynia and corneal neuropathy in association with malposition of an Ex-PRESS shunt in the peripheral cornea. Laser confocal microscopy (HRT3/RCM) of the cornea showed the presence of neuromas, decreased nerve density, and a significant increase of dendritiform immune cells consistent with our diagnosis. Initial treatment with steroid pulse therapy did not result in decreased inflammation or symptomatic improvement leading to surgical explantation of the shunt. One month after surgery, there was noticeable improvement in the patient’s pain and photoallodynia (approximately 40%) as well as the abnormalities seen on confocal microscopy. Conclusions: We hypothesize that poor Ex-PRESS shunt positioning can act as a nidus for corneal inflammation, resulting in corneal neuropathy and lowering of the nociception threshold. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.