Abstract
Purpose :
A previous study showed that patients with small fiber neuropathy (SFN), but no ocular symptoms, often have reduced corneal nerve density. However, investigations of SFN patients with ocular discomfort have not been reported. This case series aims to highlight the clinical and in vivo confocal microscopy (IVCM) presentation of patients with SFN presenting with ocular discomfort.
Methods :
This case series presents three patients who presented with neuropathic corneal pain (NCP) and were determined to have systemic SFN as proven by skin biopsy with decreased neurites. The patients were diagnosed with NCP based on their clinical presentation and IVCM findings. Demographics, clinical characteristics for signs and symptoms, as well as impact on quality of life were recorded. The nerve density for each subject was calculated by averaging the density of three selected images using NeuronJ.
Results :
The average age of the two female and one male patient was 52.3±9.9 years. The average Ocular Surface Disease Index Score was 74.1±19.5. The average OPAS 24 hour eye pain intensity score and 2-week eye pain intensity score was 8.1±1.7 and 7.8±1.9 (scale 0-10), respectively. The average OPAS non-eye pain score was 4.7±4.1. The average OPAS quality of life score was 6.7±0.1, and the average aggravating factors score and associated factors score was 6.8±1.9 and 5.6±0.4, respectively. The mean corneal staining and Schirmer’s score were 1.3±1.5 and 2.3±2.5 mm, respectively. The percent presumed centralized pain averaged at 72.5±19.6%. The average mean nerve density via IVCM was 12,343.38±7,185.11 mm/mm2. The patient with the lowest nerve density had the least centralized pain, but the patient with the most centralized pain displayed the highest nerve density. All patients were referred for skin biopsy that demonstrated decreased neurites.
Conclusions :
SFN patients can initially present with NCP, which may manifest with variable levels or corneal nerve density, depending on contribution of pain due to centralized sensitization.
This is a 2020 ARVO Annual Meeting abstract.