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Daniela Lazzarini, Alvise La Gloria Valerio, Iva Angela Fregona, Anna Mocellin, Edoardo Midena, Andrea Leonardi; NEUROPATHIC OCULAR PAIN ASSESSMENT. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6165.
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© ARVO (1962-2015); The Authors (2016-present)
The cornea possesses the richest sensory innervation of the body to detect noxious stimuli: a clinical consequence of corneal damage to nociceptive pathways is itself a disease known as neuropathic pain. The aim of the present study is to investigate the prevalence of persistent ocular pain of suspected neuropathic origin, to determine its characteristics, location, and intensity according to a self-reported questionnaire and corneal confocal microscopy investigation.
A total of 196 patients referred to Ophthalmology Unit of University of Padova over a 4-months period were included in the study. All patients underwent slit lamp examination. Intensity of pain was assessed by Visual Analogue Scale (VAS) and Facies Pain Scale (FPS), while persistence was classified as chronic if its duration was more than one month. A modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) survey was completed by 54 subjects with chronic ocular pain. In 21 subjects with ocular pain and in 10 with no pain (control group) corneal confocal microscopy and esthesiometry was performed to study nerve morphology and function.
The prevalence of chronic pain among this cohort was 28% with a VAS mean score of 54.7 ± 20.7. 27% of patients referred an acute ocular pain with a mean intensity pain of 46.6 ± 24.1 (p=0.062). 44% of the included subjects did not report any ocular pain. Chronic pain was more common in allergic keratoconjunctivitis, dry eye and blefaritis and pain experiences were endorsed as pricking, tingling, pins and needles sensations in 80% of patients. Painful area was reported to look like “more red” in 75.5% and to be abnormally sensitive/hypersensitive to touch in 51% of them. Corneal confocal microscopy performed in 11 patients with chronic pain without any corneal alteration by slit lamp reveals abnormalities at the sub-basal nerve plexus levels with presence neuromas, sproutings and inflammatory cells; control group did not shown any corneal confocal microscopy alterations.
The assessment of ocular pain characteristics using questionnaire and corneal confocal microscopy allows the clinicians to recognize the differences between nociceptive and neuropathic pain. Understanding ocular pain may prevent acute patients to become long-standing symptomatic patients. Further study will evaluate potential mechanism-based treatment of neuropathic pain.
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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