July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Patients with Clinical Signs of Dry Eye Disease Demonstrate Presence of Signs of Neuropathic Corneal Pain
Author Affiliations & Notes
  • Neslihan Dilruba Koseoglu
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Gabriela Dieckmann
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Yashar Seyed-Razavi
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, 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
  • Stephanie Cox
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Cecilia Chao
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
  • Anam Akhlaq
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Ricardo Nos�
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Zeina Salem
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Mehmet Cuneyt Ozmen
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Afsun Sahin
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
  • Pedram Hamrah
    Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center,Tufts University School of Medicine, Boston, Massachusetts, United States
    Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Neslihan Dilruba Koseoglu, System for detecting microneuromas and methods of use thereof (P); Gabriela Dieckmann, None; Yashar Seyed-Razavi, None; Arsia Jamali, None; Stephanie Cox, None; Cecilia Chao, None; Anam Akhlaq, None; Ricardo Nos�, None; Zeina Salem, None; Mehmet Ozmen, None; Afsun Sahin, None; Pedram Hamrah, Coopervision (C), Coopervision (S), System for detecting microneuromas and methods of use thereof (P)
  • Footnotes
    Support  Coopervision
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4199. doi:
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      Neslihan Dilruba Koseoglu, Gabriela Dieckmann, Yashar Seyed-Razavi, Arsia Jamali, Stephanie Cox, Cecilia Chao, Anam Akhlaq, Ricardo Nos�, Zeina Salem, Mehmet Cuneyt Ozmen, Afsun Sahin, Pedram Hamrah; Patients with Clinical Signs of Dry Eye Disease Demonstrate Presence of Signs of Neuropathic Corneal Pain. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4199.

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

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Abstract

Purpose : The dry eye disease (DED) was recently redefined as a multifactorial disease with neurosensory abnormalities contributing to its pathophysiology. Further, neuropathic corneal pain (NCP) was described as a disease with symptoms without clinical signs of DED. Our recent preliminary data showed that NCP patients without clinical signs of DED present with micro-neuromas on in vivo confocal microscopy (IVCM), suggesting they can be indicative of nerve alterations seen in these patients. This study aims to show if clinical signs of DED can coexist with micro-neuromas, as seen in NCP.

Methods : In this prospective, cross-sectional study, 91 subjects that were recruited and assessed for clinical signs of DED, including Schirmer’s test, tear break-up time (TBUT), corneal fluorescein staining (CFS), conjunctival lissamine green staining (LGS), corneal nerve changes (presence of micro-neuromas) by IVCM, and ocular discomfort levels as assessed by visual analogue scale (VAS). Eighty-four patients that had at least one clinical sign and/or micro-neuromas were included in the analyses.

Results : Out of all 84 subjects, 76 had one or more clinical signs of DED [32 (38.1%) had Schirmer’s test ≤10 mm, 46 (54.8%) had TBUT <10 seconds, 35 (41.7%) had CFS ≥1/15 and 51 (60.7%) had LGS ≥1/18], and of these subjects 46 (85.2%) presented with a micro-neuroma. The frequencies of concomitant presence of micro-neuromas (typically seen with NCP) with clinical signs of DED were 18 (56.3%), 31 (67.4%), 24 (68.6%) and 30 (58.8%) respectively. Of 54 (64.3%) subjects presenting with micro-neuromas, 46 (85.2%) had one or more concomitant clinical signs of DED, with 18 subjects (33.3%) having Schirmer’s test ≤ 10 mm, 31 (57.4%) having TBUT <10 seconds, 24 (44.4%) having CFS ≥1/15 and 30 (55.6%) had LGS ≥1/18. Interestingly, while the mean VAS scores for subjects without micro-neuromas presenting with one or more clinical DED signs was 0.41±0.20, for the subjects presenting with micro-neuromas it was significantly higher [3.35±3.12 (p<0.001) and 3.37±1.19 (p=0.015) with and without concomitant clinical DED signs respectively].

Conclusions : This study demonstrates that signs of DED can coexist with micro-neuromas that were previously seen in NCP patients. Morphological corneal nerve abnormalities, as confirmed on IVCM, may mediate the symptoms of discomfort in patients with clinical signs of DED.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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