Clinical changes after long-term management of patients suffering from dry eye disease and chronic ocular neuropathic pain

Abstract

Purpose : To evaluate the long-term evolution in DE-related symptoms and clinical signs of patients suffering from chronic ocular pain and dry eye (DE) after refractive surgery (RS).

Methods : Patients with DE and chronic ocular pain were evaluated in a first visit (V1) by an ophthalmologist and an anesthesiologist specialized in chronic pain. In a second visit (V2) 4.88± 1.14 (range, 3-7) years after V1, their evolution over time and after a variety of personalized treatment strategies was assessed. To evaluate DE symptoms, we used the Ocular Surface Disease Index (OSDI), Modified Single-Item Score Dry Eye Questionnaire (mSIDEQ) and Change in Dry Eye Symptoms Questionnaire (CDES-Q). Pain symptoms were assessed with numerical (0-10) and Wong-Baker Faces (0-10) pain rating scales. Psychological-related symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) scales. Signs evaluated were conjunctival hyperemia, fluorescein tear break-up time (TBUT), corneal and conjunctival staining, and Schirmer test with topical anesthesia.

Results : We included 26 patients (61.5% females) with a mean age of 43.1±10.0 (range, 28-62) years. At V2, 21 (80.8%) patients were using DE-related treatments (i.e. lubricants, topical cyclosporine, blood derivatives) and 12 (46.2%) were under systemic treatment for neuropathic ocular pain (i.e. tricyclic antidepressants, inhibitors of neuronal serotonin and norepinephrine reuptake, calcium channel α 2-δ ligands). General improvement at V2 (with CDES-Q) was reported by 16 (61.5%) patients. There was a decrease in DE-related symptoms (OSDI) (V1: 62.97±18.34 vs V2: 50.41±24.75; p<0.001) and in anxiety- and depression-related symptoms (V1: 20.19±9.64 vs V2: 15.19±8.71; p<0.05) with a decrease in the anxiety (V1: 11.15±4.87 vs V2: 8.62±4.70: p<0.05) and depression (V1: 9.04±5.18 vs V2: 6.58±4.61; p<0.05) subscales. There was no change in pain-related questionnaires. Evaluation of the ocular surface only showed a mild decrease in corneal staining (1.07±0.75 vs 0.60±0.63; p<0.001).

Conclusions : Long-term management of DE and chronic ocular pain after RS improved DE- and anxiety/depression-related symptoms, while chronic pain did not show changes in the questionnaires used. This highlights the difficulty in bringing ocular pain under remission, specially the neuropathic subtype.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.