CHARACTERIZATION OF PATIENTS DEVELOPING CHRONIC DRY EYE AND PAIN AFTER REFRACTIVE SURGERY

Abstract

Purpose : To describe a cohort of patients who developed persistent symptoms of dry eye (DE) and/or ocular pain after refractive surgery (RS).

Methods : Referred patients complaining of DE symptoms and/or pain >3 months after RS answered symptom questionnaires related to: 1) DE (OSDI, range 0-100; numerical/face rating scale [NRS/FRS] for main symptom, range 0-10; and modified single-item score DE-questionnaire [mSIDEQ]: frequency of 4 symptoms 0-4 scale); 2) pain (NRS/FRS, mSIDEQ); 3) mental health (hospital anxiety/depression scale [HADS]). The following ocular surface tests were done under the same normal controlled conditions in The Controlled Environment Laboratory (CELab): 1) tear osmolarity (TearLab, mean 308 mOsm/L); 2) slit-lamp exam; 3) tear break-up time (BUT; cut-off<7 sec); 4) vital stainings; 5) corneal sensitivity (Cochet-Bonnet, range 0-60 mm); 6) anesthetic test (pain increase/decrease after anaesthesia); and 7) Schirmer test.

Results : A total of 104 patients (69 women/35 men) aged 39.5±9.5 years were included; 85.6% had corneal laser RS (LASIK, 77.5%), 6.7% intraocular RS, and 7.7% had both. They developed symptoms 29.5±59.9 months (range, 1 day-288 months) after RS. DE and pain was reported by 76% and only DE by 24%.
Questionnaires indicated severe DE symptoms: NRS 7.1±2.1; FRS 6.9±2.3; mSIDEQ 18.6±4.9, 3.2±1.4 for dryness; and OSDI 60.6±22.8. Based on OSDI score 1.9% had mild (12-22), 9.6% moderate (23-32), and 88.5% had severe (score>32) DE.
Pain intensity (NRS/FRS) was 5.1±3.2/5.1±3.2 and frequency (mSIDEQ) was 2.5±1.4. Pain was mostly described as sticking needles, stabbing knives or mechanical pressure; irradiation through trigeminal territory, hyperalgesia, allodynia, headaches, and no response to common pain killers were common.
Based on HADS 19.2% had anxiety, 4.8% depression, and 27.9% both, attributable to RS outcomes. Only 2 ocular surface tests were mildly abnormal: osmolarity (316.5±20.9) and BUT (4.7±2.9). Corneal sensitivity was normal (55.7±8.4mm). After the anesthetic test in patients with pain, 55.7% felt same/more pain, suggesting a neuropathic component.

Conclusions : Despite severe DE symptoms and chronic pain, clinical signs of these post-RS patients were unremarkable. More studies in this sample of patients, including full esthesiometry, confocal microscopy, tear molecules, and conjunctival gene analyses are underway and will hopefully help understand these RS complications.

This is a 2020 ARVO Annual Meeting abstract.