The link between pain syndromes and dry eye in patients with traumatic brain injury

Abstract

Purpose : Traumatic brain injury (TBI) is a highly prevalent condition worldwide where survivors of TBI are left with long-term morbidities and higher frequency of chronic pain syndromes. Dry eye (DE) has also been linked to TBI with neuropathic pain complaints common to both individuals with DE symptoms and TBI. The purpose of our study is to evaluate relationships between TBI, chronic pain, mental health disorders, and DE.

Methods : Retrospective review of veterans’ medical records who were seen in the Veterans Administration Healthcare system (VA) between January 1, 2010 to December 31, 2014. Veterans were separated into two groups by the presence or absence of TBI. The frequencies of chronic pain conditions, mental health disorders, dry eye, and other co-morbidities were compared between the groups.

Results : Of the 3,265,894 veterans seen during the 5 year period, 3.97% (124,820) carried a diagnosis of TBI. Individuals with TBI were more likely to be younger with higher percentages of females and Hispanics compared to their counterparts without TBI. Individuals with TBI were about twice more likely to have a diagnosis of chronic pain (17.1% versus 9.4%, p<0.0005), headache (51.5% versus 18.1%, p<0.0005), insomnia (54.2% versus 34.6%, p<0.0005), depression (69.0% versus 42.0%, p<0.0005), and PTSD (54.3% versus 22.5%, p<0.0005) compared to their counterparts without TBI. The frequencies of DE (27.4% vs 25.8%, p<0.0005), ocular pain (5.2% vs 3.0%, p<0.0005) and visual discomfort (10.3% vs 2.6%, p<0.0005) were also elevated in the TBI group.

Conclusions : Several pain conditions were found to cluster in patients with TBI, including headaches, mental health disorders, and DE, tying DE to other central sensitivity disorders. As the optimal treatment of DE associated with TBI is not known, it is important evaluate novel approaches in patients with persistent DE symptoms on standard therapy.

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