June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
In Vivo Confocal Microscopy Demonstrates the Presence of Microneuromas and may Allow Differentiation of Patients with Corneal Neuropathic Pain from Dry Eye Disease
Author Affiliations & Notes
  • Hamid-Reza Moein
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Gabriela Dieckmann
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Alessandro Abbouda
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Nicholas Pondelis
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Arsia Jamali
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Zeina Salem
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
  • Pedram Hamrah
    Boston Image Reading Center, Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts, United States
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Hamid-Reza Moein, None; Gabriela Dieckmann, None; Alessandro Abbouda, None; Nicholas Pondelis, None; Arsia Jamali, None; Zeina Salem, None; Pedram Hamrah, Allergan (C), Allergan (F), Dompe (C), GlaxoSmithKline (C), GlaxoSmithKline (F), Shire (C), Shire (F)
  • Footnotes
    Support  NIH R01-EY022695 (PH), NIH R21-EY025393-01(PH), Research to Prevent Blindness Career Development Award (PH), Massachusetts Lions Eye Foundation (PH).
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2656. doi:
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      Hamid-Reza Moein, Gabriela Dieckmann, Alessandro Abbouda, Nicholas Pondelis, Arsia Jamali, Zeina Salem, Pedram Hamrah; In Vivo Confocal Microscopy Demonstrates the Presence of Microneuromas and may Allow Differentiation of Patients with Corneal Neuropathic Pain from Dry Eye Disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2656.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The diagnosis of corneal neuropathic pain (CNP) is challenging and most often difficult to differentiate from dry eye disease (DED). In addition to pain, CNP can present with similar signs and symptoms of DED. Thus, objective diagnostic tools to identify patients with CNP are needed. The purpose of this study is to compare subbasal corneal nerve and immune dendritiform cell alterations between patients with DED and CNP.

Methods : This cross-sectional, single center study included patients with DED (n=14), CNP (n=15), and age and sex-matched normal controls (n=16), who underwent central corneal laser in vivo confocal microscopy (IVCM, HRT3/RCM). Subbasal corneal nerve density and morphology (nerve beading, bead-like formation along the nerves), presence of microneuromas (enlarged nerve terminal sprouts), and dendritiform cell density (DCD) were assessed and compared between the groups by 2 masked observers.

Results : Total nerve density was decreased in both CNP patients (11.64±1.90 mm/mm2) and DED (13.63±1.56 mm/mm2) as compared to normal controls (23.90±0.92 mm/mm2; p <0.001). While total nerve density was lower in patients with CNP as compared with DED, it was not statistically significant (p=0.42). Nerve beading was present in all DED and CNP patients and in 14/16 of control group (P>0.05). Interestingly, microneuromas were observed in all patients with CNP, while they were not detected in any of the patients with DED (sensitivity and specificity of 100%). DCD was increased in both CNP (73.12±29.91 cells/mm2) and DED (82.29±18.28 cells/mm2) as compared to normal controls (24.81±4.48 cells/mm2; p=0.10). However, there was no significant difference in DCD between DED and CNP patients (p=0.79).

Conclusions : IVCM may be used as an adjunct diagnostic tool to differentiate CNP from DED. Micro-neuromas might serve as a sensitive and specific criterion in differentiating patients with CNP from DED.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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