Incomplete response to artificial tears is associated with self-reported features of neuropathic ocular pain

Abstract

Purpose: Artificial tears are first-line therapy for patients with dry eye symptoms. It is not known, however, which patients will respond to therapy. The purpose of this study was to evaluate whether certain features of dry eye were more frequent in those reporting an incomplete therapeutic response to artificial tears

Methods: Cross-sectional study of 71 individuals reporting artificial tear use (hypromellose 0.4%), at least in part, to treat dry eye associated ocular pain. An evaluation was performed to assess dry eye symptoms, as well as ocular and non-ocular pain complaints. The main outcome measures were factors associated with an incomplete response to artificial tears.

Results: By self-report, 14 patients reported no improvement, 38 partial improvement, and 19 complete improvement in ocular pain with artificial tears. Dry eye severity impacted treatment response as those with more severe symptoms were less likely to report complete improvement with artificial tears. A similar pattern was seen with respect to self-reported ocular and non-ocular pain. Patients reporting symptoms consistent with NOP including hot-burning ocular pain and/or hypersensitivity to wind were also less likely to report complete improvement with artificial tears compared to those without these complaints. In a multivariable model, hot burning ocular pain (odds ratio (OR) 0.27, 95% confidence interval (CI) 0.07-0.95, p=0.04) and a higher non-ocular pain score (OR 0.73, 95% CI 0.58-0.93, p=0.01), were significantly associated with incomplete response to artificial tears.

Conclusions: Patients who reported an incomplete response to artificial tears more frequently endorsed symptoms of NOP and more severe ocular and non-ocular pain compared to those who reported complete response to therapy.