Abstract
Purpose :
Neuropathic corneal pain (NCP) is a condition characterized by a lesion or disease of the somatosensory system accompanied by symptoms of pain, burning, light sensitivity, or discomfort, that is difficult to diagnose and manage. Prior literature has identified successful treatment modalities, but there is a lack of information on clinical NCP phenotypes. This study aims to define phenotypic presentations of NCP to improve diagnosis and future management.
Methods :
This retrospective cohort study included 290 patients diagnosed with NCP. Available information from the clinical visit was documented, including demographics, symptoms, clinical signs, ocular pain assessment survey, ocular surface disease index, medical/surgical history and serological testing. Using SPSS version 21.00, a hierarchical cluster analysis and K means analysis was completed, followed by descriptive analyses to describe clusters. ANOVA and Kruskal-Wallis tests were used to identify significant variables in forming clusters.
Results :
Clinical variables, including age, sex, corneal staining, proparacaine challenge testing, pain on a visual analog scale of 0-10, and serological markers were significant in forming phenotypic clusters (all p< 0.05). There were 6 clusters identified, with 2 clusters for each source of sensitization differentiated by presence of corneal staining, age, pain and serological tests. In peripheral NCP, patients without staining were younger males and females who had higher positive autoimmune serology (p= 0.017) and reported lower quality of life (p= 0.021) than those with staining who had higher positive antibody markers for dysimmune neuropathies (p <0.001) and were mostly older females. In mixed NCP, those with staining were mostly older females, who were more likely to have prior cataract surgery (p= 0.034) than those without staining, mostly younger females. In centralized NCP, patients with no staining were younger females who had higher reports of ocular surgery triggering pain (p= 0.008) than the centralized group with staining, who was mostly older females with common autoimmune positivity.
Conclusions :
Overall, we were able to identify phenotypic presentations of NCP based on clinical findings and in office-tests and serological markers. In practice, NCP patients may benefit from serology testing, and historical queries of pain triggers and symptoms to facilitate diagnosis.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.