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Philipp Steven, Thomas Schneider, Irene Ramesh, Sebastian E Siebelmann, Uta Gehlsen, Johannes Loeser, Dorothee Spohn; Pain In Dry-Eye Patients Without Corresponding Clinical Signs – A Retrospective Analysis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2848.
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© ARVO (1962-2015); The Authors (2016-present)
Patients with dry-eye disease (DED) frequently complain of pain symptoms such as burning, stabbing sensation, photophobia, etc that in some cases are present without clinical signs of DED. In these cases corneal neuralgia is postulated. This retrospective study was performed to analyze eye-related signs and symptoms together with psychosomatic co-morbidities and outcome of systemic anti-neuralgic therapy.
Retrospective analysis was performed from patients that were referred to our clinic with therapy-refractive dry-eye disease and the following symptom combination: Normal visual acuity, intraocular pressure (IOP), Schirmer test I and corneal fluoresceine staining in combination with pathological Ocular Surface Disease Index (OSDI) score. In addition data from those patients that had been further referred to the Pain Clinic were analyzed.
52 patients (41 female, 11 male) were identified with normal visual acuity (OD/OS: median 0.16 ±0.2/0.16 ±0.3), IOP (OD/OS: median 15.5±4.2/15.5±3.9 mmHg), Schirmer I (OD/OS: median 17±9.9/18±10.7 mm), corneal staining (OD/OS 0±0.5/0±0.4) and pathological OSDI (median 77 ±20). Corneal esthesiometry was OD/OS 5.5±1.4/6±1.5. 37 patients applied artificial tears, 10 patients cyclosporine without improvement. Topical anesthesia reduced pain on a numerical rating scale from 7.5±1.9 to 4±2.1. Co-morbidities included depression (n=9), chronic pain syndrome (n=9), anxiety disorder (n=4) as well as previous eye surgery (n=17) including LASIK, cataract surgery, PRK, cross-linking, etc. 23 patients presented at the Pain Clinic and underwent detailed examination including German pain inventory and HADS questionnaire. 13 patients received systemic therapy with Pregabalin, 5 patients Pregabalin + Amitryptilin. 9 patients did not improve, 3 improved, 2 patients became worse. 11 patients started additional psychotherapy.
Patients with discrepancy of signs and symptoms in dry-eye that are refractive to therapy show co-morbidities of psychosomatic diseases and/or previous eye surgery which implicates different sensitization pathways for proposed development of corneal neuralgia. Incomplete analgesia following topical corneal anesthesia supports the assumption of a central sensitization that would explain refractiveness to topical therapy. Few patients benefit from systemic therapy, which underlies the need for better understanding of this complex condition.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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