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Harkness BM, Chen S, Kim K, Reddy AP, McFarland TJ, Hegarty DM, Everist SJ, Saugstad JA, Lapidus J, Galor A, Aicher SA. Tear Proteins Altered in Patients with Persistent Eye Pain after Refractive Surgery: Biomarker Candidate Discovery. J Proteome Res 2024. [PMID: 38885176 DOI: 10.1021/acs.jproteome.4c00339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Some patients develop persistent eye pain after refractive surgery, but factors that cause or sustain pain are unknown. We tested whether tear proteins of patients with pain 3 months after surgery differ from those of patients without pain. Patients undergoing refractive surgery (laser in situ keratomileusis or photorefractive keratectomy ) were recruited from 2 clinics, and tears were collected 3 months after surgery. Participants rated their eye pain using a numerical rating scale (NRS, 0-10; no pain-worst pain) at baseline, 1 day, and 3 months after surgery. Using tandem mass tag proteomic analysis, we examined tears from patients with pain [NRS ≥ 3 at 3 months (n = 16)] and patients with no pain [NRS ≤ 1 at 3 months (n = 32)] after surgery. A subset of proteins (83 of 2748 detected, 3.0%) were associated with pain 3 months after surgery. High-dimensional statistical models showed that the magnitude of differential expression was not the only important factor in classifying tear samples from pain patients. Models utilizing 3 or 4 proteins had better classification performance than single proteins and represented differences in both directions (higher or lower in pain). Thus, patterns of protein differences may serve as biomarkers of postsurgical eye pain as well as potential therapeutic targets.
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Affiliation(s)
- Brooke M Harkness
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Siting Chen
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon 97239-4197, United States
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Kilsun Kim
- Proteomics Shared Resource, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Ashok P Reddy
- Proteomics Shared Resource, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Trevor J McFarland
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Deborah M Hegarty
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Steven J Everist
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Julie A Saugstad
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Jodi Lapidus
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon 97239-4197, United States
- Biostatistics & Design Program, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida 33146, United States
- Miami Veterans Affairs Hospital, Miami, Florida 33125-1624, United States
| | - Sue A Aicher
- Department of Chemical Physiology & Biochemistry, Oregon Health & Science University, Portland, Oregon 97239-4197, United States
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Valdés-Arias D, Locatelli EVT, Sepulveda-Beltran PA, Mangwani-Mordani S, Navia JC, Galor A. Recent United States Developments in the Pharmacological Treatment of Dry Eye Disease. Drugs 2024; 84:549-563. [PMID: 38652355 PMCID: PMC11189955 DOI: 10.1007/s40265-024-02031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
Dry eye disease (DED) can arise from a variety of factors, including inflammation, meibomian gland dysfunction (MGD), and neurosensory abnormalities. Individuals with DED may exhibit a range of clinical signs, including tear instability, reduced tear production, and epithelial disruption, that are driven by different pathophysiological contributors. Those affected often report a spectrum of pain and visual symptoms that can impact physical and mental aspects of health, placing an overall burden on an individual's well-being. This cumulative impact of DED on an individual's activities and on society underscores the importance of finding diverse and effective management strategies. Such management strategies necessitate an understanding of the underlying pathophysiological mechanisms that contribute to DED in the individual patient. Presently, the majority of approved therapies for DED address T cell-mediated inflammation, with their tolerability and effectiveness varying across different studies. However, there is an emergence of treatments that target additional aspects of the disease, including novel inflammatory pathways, abnormalities of the eyelid margin, and neuronal function. These developments may allow for a more nuanced and precise management strategy for DED. This review highlights the recent pharmacological advancements in DED therapy in the United States. It discusses the mechanisms of action of these new treatments, presents key findings from clinical trials, discusses their current stage of development, and explores their potential applicability to different sub-types of DED. By providing a comprehensive overview of products in development, this review aims to contribute valuable insights to the ongoing efforts in enhancing the therapeutic options available to individuals suffering from DED.
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Affiliation(s)
- David Valdés-Arias
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
| | - Elyana V T Locatelli
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 Northwest 16th Street, Miami, FL, 33125, USA
| | | | | | - Juan Carlos Navia
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA.
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 Northwest 16th Street, Miami, FL, 33125, USA.
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McNally TW, Figueiredo FC. Corneal Neuropathic Pain: A Patient and Physician Perspective. Ophthalmol Ther 2024; 13:1041-1050. [PMID: 38363459 PMCID: PMC10912060 DOI: 10.1007/s40123-024-00897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Corneal neuropathic pain (CNP) is a debilitating condition characterized by pain in the absence of a noxious stimulus. Symptoms such as ocular stinging, burning, photophobia, irritation, and a deep aching pain can be severe despite a seemingly normal ocular surface on examination. CNP may develop due to either peripheral or central sensitization. Peripheral sensitization develops due to aberrant regeneration of corneal nociceptors and nerve fibers as a result of corneal injury or disease of peripheral corneal nerves. Whereas, central sensitization develops due to upregulation of excitatory neurotransmitters as a result of chronic inflammation, which leads to amplification of neuronal response to stimuli. Unfortunately, due to the disparity in severity of symptomology and the observable signs on examination, patients' symptoms are commonly thought to be "psychological" or "functional", and patients report feeling ignored and neglected. Additionally, diagnosis is often delayed which adversely affects patient outcomes. Research to date has focused on the scientific aspects of corneal neuropathic pain: its pathophysiology, epidemiology, investigations, and management. Research into the patient personal experience and the challenges faced by individual patients and their clinicians is lacking. We present the patient and physician perspective on the journey of both patients in order to provide insights into the challenges faced by patients and physicians in the diagnosis, assessment, and management of corneal neuropathic pain.
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Affiliation(s)
- Thomas W McNally
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Francisco C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
- Bioscience Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.
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Huang JJ, Rodriguez DA, Slifer SH, Martin ER, Levitt RC, Galor A. Genome Wide Association Study of Neuropathic Ocular Pain. OPHTHALMOLOGY SCIENCE 2024; 4:100384. [PMID: 37868788 PMCID: PMC10587615 DOI: 10.1016/j.xops.2023.100384] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023]
Abstract
Purpose To conduct a genome-wide association study (GWAS) of individuals with neuropathic ocular pain (NOP) symptoms to identify genomic variants that may predispose to NOP development. Design Prospective study of individuals with NOP. Participants Three hundred twenty-nine patients recruited from the Miami Veterans Affairs eye clinic. Methods The Neuropathic Pain Symptom Inventory modified for the eye (NPSI-Eye) was completed to calculate a NPSI-Eye-Sub-Score (summed ratings of burning and wind sensitivity) as an indicator of NOP severity. A GWAS was performed for the NPSI-Eye-Sub-Score with a significance threshold of P < 5 × 10-8. A gene-based analysis was performed using the multimarker analysis of genomic annotation software (in the functional mapping and annotation of GWAS online platform). The 13 865 778 single nucleotide polymorphisms (SNPs) from our GWAS analysis were mapped to 10 834 protein coding genes, and significant genes were run through gene set enrichment analysis. Main Outcome Measures Identification of SNPs and protein products that may be associated with the development of NOP. Results One hundred seventy-one SNPs reached a threshold of P < 10-5, of which 10 SNPs reached the suggestive level of significance of P < 5 × 10-7 and 1 SNP met our genome-wide significance threshold of P < 5 × 10-8. This lead SNP, rs140293404 (P = 1.23 × 10-8), is an intronic variant found within gene ENSG00000287251 coding for transcript ENST00000662732.1. Rs140293404 is in linkage disequilibrium with exon variant rs7926353 (r2 > 0.8) within ENSG00000279046 coding for transcript ENST00000624288.1. The most significant genes from gene-based tests were matrix metalloproteinase-19 (MMP19) (P = 1.12 × 10-5), zinc finger RNA-binding motif and serine/arginine rich-1 (ZRSR1) (P = 1.48 × 10-4), CTC-487M23.8 (P = 1.79 × 10-4), receptor expression-enhancing protein-5 (REEP5) (P = 2.36 × 10-4), and signal recognition particle-19 (SRP19) (P = 2.56 × 10-4). From gene set enrichment analysis, the sensory perception (false discovery rate = 6.57 × 10-3) and olfactory signaling (false discovery rate = 1.63 × 10-2) pathways were enriched with the most significant genes. Conclusions Our GWAS revealed genes with protein products that may impact sensory perception, lending biological plausibility to a role for SNPs identified by our GWAS in the development of NOP. A better understanding of the biological relevance of these genes and pathways in the pathophysiology associated with NOP may facilitate future novel mechanism-based treatments. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jaxon J. Huang
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
- Surgical and Research Services, Miami Veterans Administration Medical Center, Miami, Florida
| | | | - Susan H. Slifer
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
| | - Eden R. Martin
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
- John T. MacDonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida
| | - Roy C. Levitt
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
- John T. MacDonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
- Surgical and Research Services, Miami Veterans Administration Medical Center, Miami, Florida
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Sloesen B, O'Brien P, Verma H, Asaithambi S, Parashar N, Mothe RK, Shaikh J, Syntosi A. Patient Experiences and Insights on Chronic Ocular Pain: Social Media Listening Study. JMIR Form Res 2024; 8:e47245. [PMID: 38358786 PMCID: PMC10905354 DOI: 10.2196/47245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Ocular pain has multifactorial etiologies that affect activities of daily life, psychological well-being, and health-related quality of life (QoL). Chronic ocular surface pain (COSP) is a persistent eye pain symptom lasting for a period longer than 3 months. OBJECTIVE The objective of this social media listening study was to better understand COSP and related symptoms and identify its perceived causes, comorbidities, and impact on QoL from social media posts. METHODS A search from February 2020 to February 2021 was performed on social media platforms (Twitter, Facebook, blogs, and forums) for English-language content posted on the web. Social media platforms that did not provide public access to information or posts were excluded. Social media posts from Australia, Canada, the United Kingdom, and the United States were retrieved using the Social Studio platform-a web-based aggregator tool. RESULTS Of the 25,590 posts identified initially, 464 posts about COSP were considered relevant; the majority of conversations (98.3%, n=456) were posted by adults (aged >18 years). Work status was mentioned in 52 conversations. Patients' or caregivers' discussions across social media platforms were centered around the symptoms (61.9%, n=287) and causes (58%, n=269) of ocular pain. Patients mentioned having symptoms associated with COSP, including headache or head pressure, dry or gritty eyes, light sensitivity, etc. Patients posted that their COSP impacts day-to-day activities such as reading, driving, sleeping, and their social, mental, and functional well-being. CONCLUSIONS Insights from this study reported patients' experiences, concerns, and the adverse impact on overall QoL. COSP imposes a significant burden on patients, which spans multiple aspects of daily life.
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Wong NSQ, Liu C, Lin MTY, Lee IXY, Tong L, Liu YC. Neuropathic Corneal Pain after Coronavirus Disease 2019 (COVID-19) Infection. Diseases 2024; 12:37. [PMID: 38391784 PMCID: PMC10887979 DOI: 10.3390/diseases12020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION This is a case report of a patient with neuropathic corneal pain after coronavirus disease 2019 (COVID-19) infection. METHODS A previously healthy 27-year-old female presented with bilateral eye pain accompanied by increased light sensitivity 5 months after COVID-19 infection. She was diagnosed with neuropathic corneal pain based on clear corneas without fluorescein staining, alongside the presence of microneuromas, dendritic cells, and activated stromal keratocytes identified bilaterally on in vivo confocal microscopy. RESULTS The patient's tear nerve growth factor, substance P, and calcitonin gene-related peptide levels were 5.9 pg/mL, 2978.7 pg/mL, and 1.1 ng/mL, respectively, for the right eye and 23.1 pg/mL, 4798.7 pg/mL, and 1.2 ng/mL, respectively, for the left eye, suggesting corneal neuroinflammatory status. After 6 weeks of topical 0.1% flurometholone treatment, decreased microneuroma size, less extensive dendritic cells, and reduced tear nerve growth factor and substance P levels were observed. The scores on the Ocular Pain Assessment Survey showed an improvement in burning sensation and light sensitivity, decreasing from 80% and 70% to 50% for both. CONCLUSIONS Neuropathic corneal pain is a potential post-COVID-19 complication that warrants ophthalmologists' and neurologists' attention.
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Affiliation(s)
- Natalie Shi Qi Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Chang Liu
- Singapore Eye Research Institute, Singapore 169856, Singapore
| | | | | | - Louis Tong
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yu-Chi Liu
- Singapore Eye Research Institute, Singapore 169856, Singapore
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
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Hossain P. Reducing the stress of corneal neuropathic pain: 'Pain without Stain'. Eye (Lond) 2024; 38:411. [PMID: 37726335 PMCID: PMC10858179 DOI: 10.1038/s41433-023-02750-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
- Eye Unit, Southampton General Hospital, Tremona Road, Southampton, UK.
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Ayoubi M, Cabrera K, Mangwani S, Locatelli EVT, Galor A. Associations between dry eye disease and sleep quality: a cross-sectional analysis. BMJ Open Ophthalmol 2024; 9:e001584. [PMID: 38177080 PMCID: PMC10773403 DOI: 10.1136/bmjophth-2023-001584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND/AIMS To investigate relationships between dry eye (DE) disease and sleep quality, with a focus on which aspects of sleep most closely relate to DE. METHODS 141 veterans (mean age: 56±5) seen at the Miami Veterans Affairs eye clinic filled out questionnaires to quantify the severity of DE symptoms (5-Item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI)) and ocular pain (Numerical Rating Scale (NRS) and Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E)). All individuals also underwent an ocular surface examination. Aspects of sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). DE metrics were examined by PSQI scores and subscores. RESULTS Most participants (76%) reported mild or greater DE symptoms (DEQ-5 ≥6). Overall, ocular symptoms were more related to sleep metrics than signs. The strongest DE symptom association was between the OSDI and sleep disturbances (PSQI subscore 5, r=0.49, p<0.0005). For DE signs, ocular surface inflammation and meibum quality were related to subjective sleep quality (PSQI subscore 1, r=0.29, p=0.03, for both). On linear regression analyses, most ocular symptom questionnaires remained associated with sleep disturbances (PSQI subscore 5: NRS (r=0.52, p<0.0005), DEQ-5 (r=0.36, p<0.0005), and OSDI (r=0.31, p<0.0005)). For DE signs, ocular surface inflammation and meibum quality remained associated with subjective sleep quality (r=0.26, p=0.01; r=0.46, p<0.0005, respectively). CONCLUSION DE symptom and ocular pain intensity were closely related to sleep metrics, most strongly to sleep disturbances. Relationships were weaker for DE signs, with subjective sleep quality relating to inflammation and meibum quality.
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Affiliation(s)
- Mohammad Ayoubi
- University of Miami Miller School of Medicine, Miami, Florida, USA
- Department of Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Kimberly Cabrera
- Research, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
| | - Simran Mangwani
- Department of Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Elyana Vittoria Tessa Locatelli
- Department of Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Anat Galor
- Department of Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
- Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
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Asiedu K. Neurophysiology of corneal neuropathic pain and emerging pharmacotherapeutics. J Neurosci Res 2024; 102:e25285. [PMID: 38284865 DOI: 10.1002/jnr.25285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/12/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
The altered activity generated by corneal neuronal injury can result in morphological and physiological changes in the architecture of synaptic connections in the nervous system. These changes can alter the sensitivity of neurons (both second-order and higher-order projection) projecting pain signals. A complex process involving different cell types, molecules, nerves, dendritic cells, neurokines, neuropeptides, and axon guidance molecules causes a high level of sensory rearrangement, which is germane to all the phases in the pathomechanism of corneal neuropathic pain. Immune cells migrating to the region of nerve injury assist in pain generation by secreting neurokines that ensure nerve depolarization. Furthermore, excitability in the central pain pathway is perpetuated by local activation of microglia in the trigeminal ganglion and alterations of the descending inhibitory modulation for corneal pain arriving from central nervous system. Corneal neuropathic pain may be facilitated by dysfunctional structures in the central somatosensory nervous system due to a lesion, altered synaptogenesis, or genetic abnormality. Understanding these important pathways will provide novel therapeutic insight.
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Affiliation(s)
- Kofi Asiedu
- School of Optometry & Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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10
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Sanchez V, Kim C, Locatelli EV, Cohen A, Cabrera K, Aenlle K, Klimas N, O’Brien R, Galor A. Dry eye symptoms and signs in United States Gulf War era veterans with myalgic encephalomyelitis/chronic fatigue syndrome. Clin Exp Ophthalmol 2024; 52:10-21. [PMID: 37953685 PMCID: PMC10873051 DOI: 10.1111/ceo.14313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND To examine ocular symptoms and signs of veterans with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnosis, ME/CFS symptoms, and controls. METHODS This was a prospective, cross-sectional study of 124 South Florida veterans in active duty during the Gulf War era. Participants were recruited at an ophthalmology clinic at the Miami Veterans Affairs Hospital and evaluated for a diagnosis of ME/CFS, or symptoms of ME/CFS (intermediate fatigue, IF) using the Canadian Consensus criteria. Ocular symptoms were assessed via standardised questionnaires and signs via comprehensive slit lamp examination. Inflammatory blood markers were analysed and compared across groups. RESULTS Mean age was 55.1 ± 4.7 years, 88.7% identified as male, 58.1% as White, and 39.5% as Hispanic. Ocular symptoms were more severe in the ME/CFS (n = 32) and IF (n = 48) groups compared to controls (n = 44) across dry eye (DE; Ocular Surface Disease Index [OSDI]: 48.9 ± 22.3 vs. 38.8 ± 23.3 vs. 19.1 ± 17.8, p < 0.001; 5 item Dry Eye Questionnaire [DEQ-5]: 10.8 ± 3.9 vs. 10.0 ± 4.6 vs. 6.6 ± 4.2, p < 0.001) and pain-specific questionnaires (Numerical Rating Scale 1-10 [NRS] right now: 2.4 ± 2.8 vs. 2.4 ± 2.9 vs 0.9 ± 1.5; p = 0.007; Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 23.0 ± 18.6 vs. 19.8 ± 19.1 vs. 6.5 ± 9.0, p < 0.001). Ocular surface parameters and blood markers of inflammation were generally similar across groups. CONCLUSION Individuals with ME/CFS report increased ocular pain but similar DE signs, suggesting that mechanisms beyond the ocular surface contribute to symptoms.
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Affiliation(s)
- Victor Sanchez
- New York University Grossman School of Medicine, New York, New York, USA
| | - Colin Kim
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Kimberly Cabrera
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
| | - Kristina Aenlle
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, Florida, USA
- Institute for Neuro-Immune Medicine, K. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, K. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Miami Veterans Affairs Center for Geriatric Research and Clinical Care Center, Miami, Florida, USA
| | - Robert O’Brien
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Miami Veterans Affairs Center for Geriatric Research and Clinical Care Center, Miami, Florida, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Yoshikawa Y, Yokoi N, Kusada N, Kato H, Sakai R, Komuro A, Sonomura Y, Sotozono C. Eye Pain Caused by Epithelial Damage in the Central Cornea in Aqueous-Deficient Dry Eye. Diagnostics (Basel) 2023; 14:30. [PMID: 38201339 PMCID: PMC10802830 DOI: 10.3390/diagnostics14010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
In this study, the severity of eye pain (EP) and associated objective findings were evaluated in aqueous-deficient dry eye (ADDE) patients using PainVision®, a quantitative pain-measuring device. This study involved 53 eyes of 53 ADDE patients (6 males and 47 females; mean age: 64.4 ± 13.4 [mean ± SD] years). Of those, 18 eyes of 18 patients underwent punctal occlusion, and EP and objective findings in those patients were evaluated before and after treatment. In all patients, the severity of EP as measured by PainVision® was assessed using the Pain Degree (PD). The median PD for the 53 patients was 30.6 µA/µA (interquartile range, 16.9-93.2), and the nasal and central corneal staining score and the upper lid-wiper epitheliopathy score were significantly correlated with PD (R = 0.33, 0.33, and 0.28, respectively) (all: p < 0.05). Using the least squares method, the central corneal staining score most significantly affected PD. In the 18 cases that underwent punctal occlusion, PD was significantly reduced (median PD: 24.8 to 7.1 µA/µA; p < 0.0001). Using the least squares method, the central corneal staining score and tear meniscus radius were significantly more influential as factors contributing to PD before and after treatment, and central corneal epithelial damage was the factor most associated with ADDE-related EP.
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Affiliation(s)
- Yamato Yoshikawa
- Department of Ophthalmology, Osaka Medical and Pharmaceutical University, Takatsuki-City 569-8686, Japan;
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Natsuki Kusada
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Rieko Sakai
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Aoi Komuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Yukiko Sonomura
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
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12
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Wan MM, Jin T, Fu ZY, Lai SH, Gao WP. Electroacupuncture Alleviates Dry Eye Ocular Pain Through TNF-ɑ Mediated ERK1/2/P2X 3R Signaling Pathway in SD Rats. J Pain Res 2023; 16:4241-4252. [PMID: 38107367 PMCID: PMC10725190 DOI: 10.2147/jpr.s436258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose This study aimed to examine electroacupuncture's influence on ocular pain and its potential modulation of the TNF-ɑ mediated ERK1/2/P2X3R signaling pathway in dry eye-induced rat models. Methods Male Sprague-Dawley rats with induced dry eye, achieved through extraorbital lacrimal gland removal, were treated with electroacupuncture. Comprehensive metrics such as the corneal mechanical perception threshold, palpebral fissure height, eyeblink frequency, eye wiping duration, behavioral changes in the open field test, and the forced swimming test were employed. Additionally, morphological changes in microglia and neurons were observed. Expression patterns of key markers, TNF-ɑ, TNFR1, p-ERK1/2, and P2X3R, in the trigeminal ganglion (TG) and spinal trigeminal nucleus caudalis (SpVc) regions, were studied with etanercept serving as a control to decipher the biochemistry of electroacupuncture's therapeutic effects. Results Electroacupuncture treatment demonstrated a notable decrease in the corneal mechanical perception threshold, improvement in palpebral fissure height, and significant reductions in both eyeblink frequency and eye wiping duration. Moreover, it exhibited a promising role in anxiety alleviation. Notably, the technique effectively diminished ocular pain by curbing microglial and neuronal activation in the TG and SpVc regions. Furthermore, it potently downregulated TNF-ɑ, TNFR1, p-ERK1/2, and P2X3R expression within these regions. Conclusion Electroacupuncture attenuated damage to sensory nerve pathways, reduced pain, and eased anxiety in dry eye-afflicted rats. The findings suggest a crucial role of TNF-ɑ mediated ERK1/2/P2X3R signaling pathway inhibition by electroacupuncture in these benefits.
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Affiliation(s)
- Mi-Mi Wan
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Tuo Jin
- Department of Ophthalmology, Kunshan Hospital of Chinese Medicine, Suzhou, People’s Republic of China
| | - Zhang-Yitian Fu
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Si-Hua Lai
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Wei-Ping Gao
- Department of Ophthalmology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
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13
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Holmes S, Reyes N, Huang JJ, Galor A, Pattany PM, Felix ER, Moulton EA. Disentangling the neurological basis of chronic ocular pain using clinical, self-report, and brain imaging data: use of K-means clustering to explore patient phenotypes. Front Neurol 2023; 14:1265082. [PMID: 38033775 PMCID: PMC10687553 DOI: 10.3389/fneur.2023.1265082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction The factors that mediate the expression of ocular pain and the mechanisms that promote chronic ocular pain symptoms are poorly understood. Central nervous system involvement has been postulated based on observations of pain out of proportion to nociceptive stimuli in some individuals. This investigation focused on understanding functional connectivity between brain regions implicated in chronic pain in persons reporting ocular pain symptoms. Methods We recruited a total of 53 persons divided into two cohorts: persons who reported no ocular pain, and persons who reported chronic ocular pain, irrespective of ocular surface findings. We performed a resting state fMRI investigation that was focused on subcortical brain structures including the trigeminal nucleus and performed a brief battery of ophthalmological examinations. Results Persons in the pain cohort reported higher levels of pain symptoms relating to neuropathic pain and ocular surface disease, as well as more abnormal tear metrics (stability and tear production). Functional connectivity analysis between groups evinced multiple connections exemplifying both increases and decreases in connectivity including regions such as the trigeminal nucleus, amygdala, and sub-regions of the thalamus. Exploratory analysis of the pain cohort integrating clinical and brain function metrics highlighted subpopulations that showed unique phenotypes providing insight into pain mechanisms. Discussion Study findings support centralized involvement in those reporting ocular-based pain and allude to mechanisms through which pain treatment services may be directed in future research.
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Affiliation(s)
- Scott Holmes
- Pain and Affective Neuroscience Center, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Pediatric Pain Pathway Lab, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Nicholas Reyes
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Jaxon J. Huang
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Anat Galor
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Pradip M. Pattany
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Elizabeth R. Felix
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, United States
- Physical Medicine and Rehabilitation, University of Miami, Miami, FL, United States
| | - Eric A. Moulton
- Pain and Affective Neuroscience Center, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Brain and Eye Pain Imaging Lab, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
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14
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Lafreniere JD, Szczesniak AM, Courtney E, Kelly MEM, Faktorovich EG. Topical analgesics for acute corneal pain: current options and emerging therapeutics. J Cataract Refract Surg 2023; 49:1160-1167. [PMID: 37232414 DOI: 10.1097/j.jcrs.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Acute corneal pain is a common complaint that causes significant distress to patients and continues to challenge therapeutic avenues for pain management. Current topical treatment options have marked limitations in terms of both efficacy and safety, thus often prompting the adjunctive use of systemic analgesics, including opioids. In general, there have not been extensive advancements in pharmacologic options for the management of corneal pain over the past several decades. Despite this, multiple promising therapeutic avenues exist which hold the potential to transform the ocular pain landscape, including druggable targets within the endocannabinoid system. This review will summarize the current evidence base for topical nonsteroidal anti-inflammatory drugs, anticholinergic agents, and anesthetics before focusing on several potential avenues in the setting of acute corneal pain management, including autologous tear serum, topical opioids and endocannabinoid system modulators.
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Affiliation(s)
- J Daniel Lafreniere
- From the Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (Lafreniere, Szczesniak, Courtney, Kelly); Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Pacific Vision Institute, San Francisco, California (Faktorovich)
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15
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Gómez Molins A, Adami C, Shing H, Monticelli P. Persistent socket pain in a dog after the enucleation of the eye and its clinical management. Vet Med Sci 2023; 9:2447-2451. [PMID: 37882359 PMCID: PMC10650324 DOI: 10.1002/vms3.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023] Open
Abstract
Persistent socket pain is a condition described in humans after enucleation of the eye. This report aims at describing this condition in dogs. A 10-year-old male-neutered crossbreed was presented to the referral veterinary surgeon for enucleation of the right ocular globe. Anaesthesia and surgery were uneventful although during the postoperative period the dog was reluctant to open the mouth and to be explored by the referral veteterinary surgeon. Despite treatment with meloxicam, paracetamol and tramadol, no improvements were observed. Ten weeks after surgery, the dog was referred to the Dick White referrals for further investigations. Ophthalmic examination was normal, though palpation of the wound triggered an avoidance response. Magnetic resonance imaging showed changes compatible with orbital cellulitis. The area of interest was evaluated with the use of the mechanical Von Frey filaments. A response, characterised by sudden turning of the head and attempts to withdraw it, was evoked with filament 4.93 (8.0 g) during stimulation of the periorbital area. After induction of anaesthesia, an ultrasound-guided injection containing levobupivacaine 0.5% and methylprednisolone was performed within the retrobulbar area. Three hours after recovery from anaesthesia, no discomfort was observed during palpation of the area. Re-evaluation was performed with the Von Frey filaments; no response could be evoked during testing with all 20 filaments (from 2.36 to 6.65) applied on either side of the face. The patient was discharged with a course of gabapentin and, 3 weeks after the intervention, the dog showed no clinical signs of pain. Persistent socket pain is an unpleasant sensation at the level of the enucleated orbit, and it should be regarded as a challenging condition to diagnose and treat. The MRI findings appeared to be essential to select the most appropriate interventional treatment. The injection of local anaesthetic and steroid into the retrobulbar space was useful for both confirming the diagnosis and treating pain by reducing the peripheral signalling and decreasing the residual inflammation.
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Affiliation(s)
| | - Chiara Adami
- Department of Veterinary MedicineUniversity of CambridgeCambridgeCambridgeshireUK
| | - Hannah Shing
- Dick White ReferralsSix Mile BottonCambridgeshireUK
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16
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Kaur S, Sohnen P, Swamynathan S, Du Y, Espana EM, Swamynathan SK. Molecular nature of ocular surface barrier function, diseases that affect it, and its relevance for ocular drug delivery. Ocul Surf 2023; 30:3-13. [PMID: 37543173 PMCID: PMC10837323 DOI: 10.1016/j.jtos.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
The structural and functional integrity of the ocular surface, a continuous epithelial structure comprised of the cornea, the conjunctiva, and the ductal surface of the lacrimal as well as meibomian glands, is crucial for proper vision. The ocular surface barrier function (OSBF), sum of the different types of protective mechanisms that exist at the ocular surface, is essential to protect the rest of the eye from vision-threatening physical, chemical, and biological insults. OSBF helps maintain the immune privileged nature of the cornea and the aqueous humor by preventing entry of infectious agents, allergens, and noxious chemicals. Disruption of OSBF exposes the dense nerve endings of the cornea to these stimuli, resulting in discomfort and pain. This review summarizes the status of our knowledge related to the molecular nature of OSBF, describes the effect of different ocular surface disorders on OSBF, and examines the relevance of this knowledge for ocular drug delivery.
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Affiliation(s)
- Satinder Kaur
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA
| | - Peri Sohnen
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA
| | - Sudha Swamynathan
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA
| | - Yiqin Du
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA
| | - Edgar M Espana
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA
| | - Shivalingappa K Swamynathan
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd., Room 2114, Tampa, FL 33612. USA.
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17
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Raolji S, Kumar P, Galor A. Ocular surface itch and pain: key differences and similarities between the two sensations. Curr Opin Allergy Clin Immunol 2023; 23:415-422. [PMID: 37490616 PMCID: PMC10529639 DOI: 10.1097/aci.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW To review the pathophysiology and treatment of ocular itch and pain, encompassing nociceptive and neuropathic categories. RECENT FINDINGS Ocular itch and pain are sensations that arise from activation of ocular surface polymodal nerves. Nociceptive itch, commonly comorbid with ocular pain complaints, is mainly driven by a histamine-mediated type 1 hypersensitivity reaction. Beyond topical therapy, novel drug delivery systems are being explored to improve ocular residence time of nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines. Nociceptive ocular pain can be driven by a variety of factors. Treatment focuses on addressing the causative sources of pain. Neuropathic ocular itch and pain are driven by nerve damage and dysfunction and as such, topical and oral neuromodulation have been explored as treatments. Oral neuromodulators include alpha 2 delta ligands, tricyclic antidepressants (TCAs), and low dose naltrexone. Novel therapies are being evaluated for both modalities such as difelikefalin (κ-opioid receptor agonist) for neuropathic itch and libvatrep (transient receptor potential vanilloid 1 antagonist) for neuropathic pain. SUMMARY Both ocular itch and pain can be driven by nociceptive and/or neuropathic mechanisms. Identifying contributors to abnormal ocular sensations is vital for precise medical care. Novel therapeutics for these conditions aim to improve patient outcomes and quality of life.
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Affiliation(s)
- Shyamal Raolji
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Preet Kumar
- Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL 33125
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18
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Le DTM, Kandel H, Watson SL. Evaluation of ocular neuropathic pain. Ocul Surf 2023; 30:213-235. [PMID: 37748645 DOI: 10.1016/j.jtos.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
AIM To identify and assess the quality of current validated questionnaires that could be used to evaluate ocular neuropathic pain and its associated aetiologies. METHODS A literature search was performed on MEDLINE, PubMed, EMBASE, PsycINFO and The Cochrane Library. Articles evaluating questionnaires for ocular neuropathic pain and its associated aetiologies were included. Data on psychometric properties, validity, and reliability of the questionnaires was extracted and analysed using a set of quality criteria. Clinical and demographical associations with ocular neuropathic pain were also reviewed. RESULTS The search generated 1738 results with 61 publications meeting the inclusion criteria. The 61 publications covered 28 questionnaires including 3 ocular pain, 12 dry eye disease, 2 blepharitis, 2 refractive surgery, 3 contact lens wear, 3 Sjogren's Syndrome, and 3 that were non-disease-specific. Only 57 publications provided enough data on psychometric properties and validity of the questionnaire to be included for quality assessment. The Contact Lens Discomfort Index (CLDI) had the highest rated psychometric properties, whereas the English version of the Ocular Comfort Index (OCI) provided the most data on psychometric properties (9 out of 10 criteria). Most ocular pain and disease-specific questionnaires contained appropriate items to assess ocular pain in specific populations. However, non-disease-specific ophthalmic questionnaires demonstrated poor reliability and validity when evaluating ocular pain. CONCLUSION Ocular pain questionnaires can potentially diagnose ocular neuropathic pain. Disease-specific questionnaires were limited to their target populations, and non-disease-specific ophthalmic questionnaires were unreliable. Further studies are required to determine the most appropriate questionnaire to evaluate ocular neuropathic pain.
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Affiliation(s)
- Damien Tuan-Man Le
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia.
| | - Himal Kandel
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia
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19
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Graca M, Sarantopoulos K, Horn DB. Chemical toxic exposures and chronic ocular pain. FRONTIERS IN TOXICOLOGY 2023; 5:1188152. [PMID: 37637478 PMCID: PMC10448520 DOI: 10.3389/ftox.2023.1188152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
Chronic ocular pain is a common, debilitating chronic pain condition with significant morbidity and negative impact in patients' quality of life. Several, diverse types of insults to the ocular surface can lead to acute, and under certain conditions to chronic ocular pain, and these include toxic irritants. Exposure of ocular surface to toxic irritants, in addition to direct tissue injury, carries the capacity to generated intense immune and neuronal responses with hyper-excitability, sensitization and chronic pain. Because, chronic ocular pain subsequent to toxic exposures is relatively unrecognized clinical entity, this brief review highlights pertinent concepts of its epidemiology, pathogenesis/pathophysiology, clinical progression, with recommendations for its clinical management that clinicians may find helpful. Suppression of pain signaling, generating neuronal sensitization, and prevention of chronicity of neuropathic pain is particularly emphasized in this respect.
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Affiliation(s)
- Mateusz Graca
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - Konstantinos Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Danielle Bodzin Horn
- Department of Anesthesiology, Perioperative Medicine and Pain Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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20
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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21
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Chester T, Garg S(S, Johnston J, Ayers B, Gupta P. How Can We Best Diagnose Severity Levels of Dry Eye Disease: Current Perspectives. Clin Ophthalmol 2023; 17:1587-1604. [PMID: 37304329 PMCID: PMC10254642 DOI: 10.2147/opth.s388289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Dry eye disease (DED) is a common ocular condition, but the diagnosis relative to other ocular conditions and the evaluation of severity of the condition has often been difficult. This challenge can be due to clinical signs and symptoms not always correlating with each other. An understanding of the various components which create the condition, as well as the diagnostic measures used to evaluate these components, is useful to the clinician working with DED patients. This review paper will discuss traditional diagnostic options, diagnostic imaging, and Advanced Point of Care testing capabilities to determine the severity level of dry eye disease more adequately.
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Affiliation(s)
| | - Sumit (Sam) Garg
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California-Irvine, Irvine, CA, USA
| | - Josh Johnston
- Georgia Eye Partners, Atlanta, GA, USA
- Southern College of Optometry, Memphis, TN, USA
| | - Brandon Ayers
- Ophthalmic Partners PC, Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Preeya Gupta
- Triangle Eye Consultants, Raleigh, NC, USA
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
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22
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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Caycedo Lozano AR, Arias Ortiz WA, Martín V, Ramírez S, Medina Siervo CA. Analysis of diagnostic tests in patients with dry eye and hypothyroidism: an observational study. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:163-169. [PMID: 36114138 DOI: 10.1016/j.oftale.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Colombia is a country with a high prevalence of hypothyroidism, approximately 18.5% compared to the rest of Latin American countries, which is estimated at 10%. That is why in the ophthalmology consultation we find a large proportion of patients with this disease and who also present symptoms of dry eye. When conducting a search in the medical literature, most publications refer to the clinical presentation of dry eye in hyperthyroidism, which is why the main objective of this study is to evaluate tear function tests in the diagnosis of dry eye in patients with hypothyroidism. METHODS This is an observational, cross-sectional study carried out in the period between May and December 2019 in the ocular surface unit of the Ophthalmic Technology Center (CTO) in Bogotá. The tests of: OSDI test (Ocular Surface Disease Index), Schirmer type I, tear meniscus height, NiBUT, Osmolarity, Ferning test, Lisamine Green test of 59 patients with Dry Eye Disease (DED) and history of hypothyroidism. RESULTS Schirmer type I and NiBUT tests were the parameters that presented the highest percentage of severity, while lissamine green staining and meniscometry showed a tendency to normality. CONCLUSIONS The population of this study presents a mixed type dry eye without epithelial cell damage.
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Affiliation(s)
| | - W A Arias Ortiz
- Grupo de investigación Medicina Comunitaria y Salud Colectiva, Universidad del Bosque, Bogotá, Colombia
| | - V Martín
- Clínica de Optometría San Francisco, Bogotá, Colombia; Universidad de la Salle - Edificio Centro Médico de la Sabana, Bogotá, Colombia
| | - S Ramírez
- Universidad de la Salle - Edificio Centro Médico de la Sabana, Bogotá, Colombia
| | - C A Medina Siervo
- Fundación Universitaria Sanitas, Unidad de Superficie Ocular, Centro de Tecnología Oftálmica, Bogotá, Colombia
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Katagiri A, Tsubota K, Mikuzuki L, Nakamura S, Toyofuku A, Kato T, Bereiter DA, Iwata K. Diquafosol sodium reduces neuronal activity in trigeminal subnucleus caudalis in a rat model of chronic dry eye disease. Neurosci Lett 2023; 792:136939. [PMID: 36341926 DOI: 10.1016/j.neulet.2022.136939] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Patients with persistent and severe dry eye disease (DED) have corneal hypersensitivity, resulting in ocular pain, and diquafosol sodium, a potent P2Y2 receptor agonist, is commonly used to improve the resultant tear film stability. This study determined the effects of diquafosol instillation on the suppression of trigeminal subnucleus caudalis (Vc) neuronal activity and ocular pain by enhancing tear film stability in the model for chronic DED. The effects of diquafosol on the ocular surface were assessed by the topical application for 28 days, starting from the 14th day since unilateral exorbital gland removal (chronic DED). Loss of tear volume secretion in chronic DED rats was significantly reversed by diquafosol instillation after 28 days, compared with saline treatment. The number of eyeblinks and pERK-IR neurons in the superficial laminae of Vc following hypertonic saline administration to the ocular surface was lower in diquafosol-treated chronic DED rats than in saline-treated rats. The neuronal activity evoked by hypertonic saline and mechanical stimulation along with the spontaneous neuronal activity in the superficial laminae of the Vc were suppressed in diquafosol-treated chronic DED rats. These findings suggest that ocular surface instillation of diquafosol for 28 days attenuates the neuronal hyperactivity in the Vc and the ocular pain that often occurs in chronic DED.
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Affiliation(s)
- Ayano Katagiri
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita-shi, Osaka 565-0871, Japan.
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; Tsubota Laboratory, Inc., 34 Shinanomachi, Shinjuku-ku, Tokyo 160-0016 Japan
| | - Lou Mikuzuki
- Division of Geriatric Dentistry, Department of Critical Care Dentistry, Kanagawa Dental University, 82 Inaoka-cho Yokosuka-shi Kanagawa, 238-8580, Japan
| | - Shigeru Nakamura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Tokyo Medical and Dental University (TMDU) Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Takafumi Kato
- Department of Oral Physiology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
| | - David A Bereiter
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN 55455, USA
| | - Koichi Iwata
- Department of Physiology, Nihon University School of Dentistry, 1-8-13 Kandasurugadai, Chiyoda-ku, Tokyo 101-8310, Japan
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Yu K, Asbell PA, Shtein RM, Ying GS. Dry Eye Subtypes in the Dry Eye Assessment and Management (DREAM) Study: A Latent Profile Analysis. Transl Vis Sci Technol 2022; 11:13. [PMID: 36383391 PMCID: PMC9680588 DOI: 10.1167/tvst.11.11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose Dry eye disease (DED) is a heterogeneous condition with poorly characterized subtypes. The DREAM study was a large multicenter randomized clinical trial that did not find omega-3 to be more effective than placebo in treating symptomatic DED. We performed secondary analysis of DREAM data to characterize DED subtypes and their omega-3 response. Methods A total of 535 patients with moderate-to-severe DED were randomized to omega-3 or placebo treatment for one year. We used latent profile analysis to identify subtypes based on baseline Ocular Surface Disease Index, tear break-up time (TBUT), anesthetized Schirmer's test, corneal and conjunctival staining, and meibomian gland dysfunction (MGD). We evaluated omega-3's effect for each subtype using generalized linear regression. Results Five clinically meaningful DED subtypes were identified. They differed significantly in sex (P < 0.001) and race (P = 0.02). Subtype 1 had the most severe DED signs yet milder symptoms and was associated with more Sjögren's syndrome (21%, P < 0.001). Subtype 2 had the mildest DED signs except MGD. Subtype 3 had the most severe symptoms, out of proportion to DED signs. Subtype 4 had relatively milder symptoms and MGD. Subtype 5 had severe MGD and TBUT and was associated with rosacea (29%, P = 0.04). Omega-3 was not significantly more beneficial than placebo for any subtype. Conclusions Five clinically meaningful DED subtypes differed significantly in demographics, symptoms, signs, and systemic disease associations. Omega-3 was not significantly more effective than placebo for any subtype. Translational Relevance T3 translational research identifying subtypes in the DREAM study can improve DED clinical classification and targeted management.
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Affiliation(s)
- Kimberley Yu
- Department of Ophthalmology, University of Southern California Roski Eye Institute, Los Angeles, CA, USA
| | - Penny A. Asbell
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Roni M. Shtein
- Department of Ophthalmology, University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Zeng W, Lou H, Huang Q, Li K, Liu X, Wu K. Eliciting blinks by transcutaneous electric nerve stimulation improves tear fluid in healthy video display terminal users: A self-controlled study. Medicine (Baltimore) 2022; 101:e31352. [PMID: 36343050 PMCID: PMC9646660 DOI: 10.1097/md.0000000000031352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We aimed to elicit strong blinks among healthy video display terminal (VDT) users by periorbital transcutaneous electric nerve stimulation (TENS) and evaluate its impact on the tear fluid and visual task. Appropriate TENS conditions were evaluated to evoke strong blinks under minimum discomfort. Seventeen healthy VDT users with noninvasive Keratograph first breakup time (NIKf-BUT) 5-15 s and Ocular Surface Disease Index (OSDI) scores < 15 were recruited in this study. Before the trial, noninvasive Keratograph average breakup time (NIKa-BUT), tear meniscus height (TMH) and OSDI scores were evaluated. Before each TENS session, the volunteers played Tetris while the corresponding blink rate and Tetris scores were recorded. Then, the participants underwent 30 minutes of TENS, which evoked blinking of their right eye 20 times per minute. Tetris scores were evaluated again during TENS. The Tetris scores and corresponding blink rate were assessed after each TENS session while NIKa-BUT, TMH and OSDI scores were recorded after the third and sixth TENS sessions. We found that OSDI scores declined significantly after the sixth TENS (P = .003). The NIKa-BUT of the right eye was promoted after the sixth TENS (P = .02), and the TMH was higher after the third and sixth TENS in both eyes (P = .03, P = .03 for right eyes respectively, P = .01, P = .01 for left eyes respectively). There was no significant difference between the adjusted Tetris scores before and during TENS (P = .12). The blink rate before and after TENS were unaffected after 6 sessions (P = .61). The results indicated that periorbital TENS effectively ameliorated ocular irritation and improved tear secretion and tear film stability by eliciting strong blinks in healthy VDT users without disturbing the visual task.
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Affiliation(s)
- Weiting Zeng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Han Lou
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Quanbin Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kunke Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiuping Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kaili Wu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- * Correspondence: Kaili Wu, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China (e-mail: )
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Park SH, Hwang JS, Shin YJ. Effect of multivitamin drug on intractable dry eye symptoms. Front Med (Lausanne) 2022; 9:978107. [PMID: 36148465 PMCID: PMC9486468 DOI: 10.3389/fmed.2022.978107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Dry eye is a disorder of tear film and ocular surface characterized by ocular discomforts. It is associated with multiple causes and sometimes intractable. We investigated the effect of oral multivitamin supplementation (MVG) on dry eyes. Tear break-up time (TBUT), fluorescein ocular surface staining score, and tear secretion Schirmer test were measured in dry eye patients refractory to conventional topical treatment. The ocular surface disease index (OSDI), visual analog pain score (VAS), and modified standardized patient evaluation of eye dryness questionnaire were analyzed. In total, 42 eyes of 42 patients were included. TBUT increased at 1 and 3 months compared to baseline (p < 0.05). OSDI decreased at 1 and 3 months compared to baseline (p < 0.05). VAS score, impact on life, and frequency of total symptoms decreased at 3 months compared to baseline (p < 0.05). Oral administration of MVG, a vitamin complex formulation, was effective in stabilizing tear stability and alleviating symptoms in patients with intractable dry eye. Thus, it may be a viable treatment option for intractable dry eye.
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Affiliation(s)
- Se Hie Park
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Jin Sun Hwang
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul, South Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul, South Korea
- *Correspondence: Young Joo Shin,
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Maskin SL. Successful reversal of neuropathic eye pain by treatment of occult ocular surface disease: Case series and implications. Am J Ophthalmol Case Rep 2022; 27:101662. [PMID: 35873369 PMCID: PMC9301504 DOI: 10.1016/j.ajoc.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/25/2022] [Accepted: 07/10/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose To report the successful approach to managing neuropathic dry eye-like pain (NP) in three consecutive patients described as severe: 1) “burning fire,” “burning acid,” and “horrible burning pain” with hyperalgesia and allodynia, 2) refractory to topical anesthetic (TA), and 3) without surface hyperemia nor vital staining. Observations Two of three patients' pain was reversed with significant symptom relief within 48 hours by identification of occult obstructive Meibomian gland dysfunction (o-MGD) and treatment using Meibomian gland probing (MGP) with intraductal steroid lavage (MGP(s)) and aqueous tear deficiency (ATD) treated with punctal thermocautery (PO). The third patient's pain was reversed within one week after treatment of superior conjunctivochalasis (CCh) using amniotic membrane surface reconstruction and ATD using PO with subsequent MGP and MGP(s) for o-MGD. Conclusions and importance It has been generally thought that central (NP) is strongly suggested by triad of 1) severe chronic burning pain with hyperalgesia and allodynia, 2) refractory to TA with 3) minimal signs. In this three-case series, treatment of occult surface disease consistently led to symptom reversal. Results may represent salutary effect of successful treatment to suppress nociceptive inflammation leading to reversal of central NP. Alternatively, the current triad of diagnostic criteria may be unable to differentiate centralized NP from peripheral sensitization alone, thereby requiring rigorous examination to uncover occult, yet treatable, surface disease to restore eye comfort and reverse psychosocial sequelae when possible. Furthermore, rigorous targeting of surface disease in patients with this pain triad may obviate unnecessary systemic treatments with associated risks of serious side effects.
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Forristal MT, Stephenson KAJ. Differentiating primary dry eye disease from ocular neuropathic pain: implications for symptom management. Clin Exp Optom 2022:1-7. [PMID: 36004515 DOI: 10.1080/08164622.2022.2111199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CLINICAL RELEVANCE Eyecare practitioners' management of ocular surface disease is essential in managing increasing dry eye disease (DED) presentations including ocular neuropathic pain (ONP). Topical Proxymetacaine offers a simple, readily available and practical method of detecting ONP in practice and can be used to differentiate ONP from DED by eyecare practitioners, when accompanied with an anterior segment examination. BACKGROUND Differentiating DED from ONP presents a significant opportunity to eyecare providers, allowing appropriate treatment choices for more adequate symptom control, greater patient satisfaction, and reduced emergent re-presentations. This study aims to differentiate patients presenting with DED symptoms into DED or ONP using a simple diagnostic tool, which can be used in practice to allocate appropriate treatment options for the patient's respective condition. A comparison of the prevalence of presentations of ONP presenting with DED symptoms in hospital ophthalmology settings and in optometric primary care settings will also be made. METHODS Patients with symptoms of DED were opportunistically recruited as they presented to ophthalmology outpatient clinics and primary care optometric services. Patients were then categorised as DED, ONP, or mixed DED/ONP based on their subjective response 30 seconds post-Proxymetacaine Hydrochloride 2% instillation. RESULTS Twenty-one patients were recruited, including 12 patients from ophthalmologic outpatient clinics and nine patients from primary care optometric services. Twelve patients were identified to have primary DED, while nine patients were identified to have ONP. 43% of patients presenting with DED symptoms had features of neuropathic pain in ophthalmologic outpatient presentations compared to 44% of patients in primary care optometric services. CONCLUSION Categorising DED and ONP patients by their response to Proxymetacaine can be used as a simple diagnostic tool in guiding future patient management and can be indicative of their potential response to topical therapies. The use of topical Proxymetacaine and the resultant change in ocular pain score can facilitate selection of patients who may benefit from centrally acting neuropathic pain agents over topical ocular therapy.
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Affiliation(s)
- Mark T Forristal
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Kirk A J Stephenson
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Wang M, Yennam S, Pflugfelder S. Initial experiences using plasma rich in growth factors to treat keratoneuralgia. Front Med (Lausanne) 2022; 9:946828. [PMID: 36091697 PMCID: PMC9448984 DOI: 10.3389/fmed.2022.946828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022] Open
Abstract
Keratoneuralgia, a clinical diagnosis of sensitized corneal pain without visible ocular surface damage, generally has minimal response to conventional therapies. Causes include refractive surgery and chronic dry eye. We evaluated the efficacy of Plasma Rich in Growth Factors (PRGF), a novel treatment prepared using a commercially available kit, in patients with keratoneuralgia. A retrospective chart review identified patients who had the clinical diagnosis of keratoneuralgia and were treated with PRGF for at least 3 months from October 2015 to April 2020 at a single academic institution. Both objective eye exam findings and concurrent treatments were obtained at baseline, 3 months, and final visit (if available). A questionnaire was administered to identified patients, including symptoms scores measured with a visual analog scale. The results of this survey and other objective findings were compared before and after PRGF treatment. 16 out of 32 patients (50%) with a mean follow-up period of 33 ± 26 months answered the questionnaire. Refractive surgeries were the cause of keratoneuralgia in 14 patients (87.5%), with LASIK the most common procedure (11 patients, 69%). There were no adverse events recorded or reported. Symptom scored by VAS in a modified Symptoms Assessment in Dry Eye questionnaire significantly decreased after PRGF use (85 ± 16 to 45 ± 33, p = 0.0002). Ten patients (63%) reported PRGF is superior to other therapy and would recommend to others. There were no significant trends in visual acuity, objective exam findings, or concurrent treatments after PRGF treatment. PRGF is safe and can potentially alleviate symptoms in patients with keratoneuralgia, a rare but devastating complication after refractive surgery. Prospective trial is indicated to explore PRGF as a potentially useful treatment for keratoneuralgia.
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Galor A, Hamrah P, Haque S, Attal N, Labetoulle M. Understanding chronic ocular surface pain: An unmet need for targeted drug therapy. Ocul Surf 2022; 26:148-156. [PMID: 35970433 DOI: 10.1016/j.jtos.2022.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
Chronic ocular surface pain (COSP) may be defined as a feeling of pain, perceived as originating from the ocular surface, that persists for >3 months. COSP is a complex multifactorial condition associated with several risk factors that may significantly interfere with an individual's daily activities, resulting in poor quality of life (QoL). COSP is also likely to have a high burden on patients with substantial implications on global healthcare costs. While patients may use varied terminology to describe symptoms of COSP, any ocular surface damage in the ocular sensory apparatus (nociceptive, neuropathic, inflammatory, or combination thereof) resulting in low tear production, chronic inflammation, or nerve abnormalities (functional and/or morphological), is typically associated with COSP. Considering the heterogeneity of this condition, it is highly recommended that advanced multimodal diagnostic tools are utilized to help discern the nociceptive and neuropathic pain pathways in order to provide targeted treatment and effective clinical management. The current article provides an overview of COSP, including its multifactorial pathophysiology, etiology, prevalence, clinical presentation, impact on QoL, diagnosis, current management, and unmet medical needs.
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Affiliation(s)
- Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Centre and Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Pedram Hamrah
- Tufts Medical Centre, New England Eye Center, 260 Tremont Street Biewend Building, Boston, MA, USA
| | | | - Nadine Attal
- CHU Paris IdF Ouest - Hôpital Ambroise Paré, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, INSERM U 987 and Université Paris Saclay, France
| | - Marc Labetoulle
- Service d'Ophtalmologie, hôpital Bicêtre, AP-HP, Université Paris Saclay, 94275, Le Kremlin-Bicêtre, France; IMVA-HB/IDMI, CEA, Inserm U1184, 92265, Fontenay-aux-Roses, France.
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Patel S, Mittal R, Sarantopoulos KD, Galor A. Neuropathic ocular surface pain: Emerging drug targets and therapeutic implications. Expert Opin Ther Targets 2022; 26:681-695. [PMID: 36069761 PMCID: PMC9613591 DOI: 10.1080/14728222.2022.2122438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Dysfunction at various levels of the somatosensory system can lead to ocular surface pain with a neuropathic component. Compared to nociceptive pain (due to noxious stimuli at the ocular surface), neuropathic pain tends to be chronic and refractory to therapies, making it an important source of morbidity in the population. An understanding of the options available for neuropathic ocular surface pain, including new and emerging therapies, is thus an important topic. AREAS COVERED This review will examine studies focusing on ocular surface pain, emphasizing those examining patients with a neuropathic component. Attention will be placed toward recent (after 2017) studies that have examined new and emerging therapies for neuropathic ocular surface pain. EXPERT OPINION Several therapies have been studied thus far, and continued research is needed to identify which individuals would benefit from specific therapies. Gaps in our understanding exist, especially with availability of in-clinic diagnostics for neuropathic pain. A focus on improving diagnostic capabilities and researching gene-modulating therapies could help us to provide more specific mechanism-based therapies for patients. In the meantime, continuing to uncover new modalities and examining which are likely to work depending on pain phenotype remains an important short-term goal.
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Affiliation(s)
- Sneh Patel
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rhiya Mittal
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Konstantinos D. Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Anat Galor
- University of Miami Miller School of Medicine, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Surgical services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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34
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Peripheral Trigeminal Nerve Blocks for Chronic Orbital Pain: Clinical Features and Outcomes. Ophthalmic Plast Reconstr Surg 2022; 38:369-376. [DOI: 10.1097/iop.0000000000002120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huang R, Su C, Fang L, Lu J, Chen J, Ding Y. Dry eye syndrome: comprehensive etiologies and recent clinical trials. Int Ophthalmol 2022; 42:3253-3272. [PMID: 35678897 PMCID: PMC9178318 DOI: 10.1007/s10792-022-02320-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/18/2022] [Indexed: 12/07/2023]
Abstract
Dry eye syndrome (DES) is multifactorial and likely to be a cause of concern more so than ever given the rapid pace of modernization, which is directly associated with many of the extrinsic causative factors. Additionally, recent studies have also postulated novel etiologies that may provide the basis for alternative treatment methods clinically. Such insights are especially important given that current approaches to tackle DES remains suboptimal. This review will primarily cover a comprehensive list of causes that lead to DES, summarize all the upcoming and ongoing clinical trials that focuses on treating this disease as well as discuss future potential treatments that can improve inclusivity.
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Affiliation(s)
- Ruojing Huang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Caiying Su
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Lvjie Fang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Jiaqi Lu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China
| | - Jiansu Chen
- Institute of Ophthalmology, Medical College, Jinan University, Huangpu Avenue West 601, Tianhe District, Guangzhou, 510632, China.
| | - Yong Ding
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Huangpu Avenue West 613, Tianhe District, Guangzhou, 510630, China.
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Elevated Neuropeptides in Dry Eye Disease and Their Clinical Correlations. Cornea 2022; 42:557-564. [PMID: 37000701 DOI: 10.1097/ico.0000000000003069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal of this study was to assess neuropeptide levels in patients with dry eye disease (DED) and investigate their correlations with clinical characteristics. METHODS This study included 38 eyes of 38 patients diagnosed with DED (DED group) and 38 eyes of 38 healthy volunteers without DED (control group). Ocular surface evaluation was performed. The severity of dry eye symptoms and signs in the DED group was graded. Neuropeptides [substance P (SP), alpha-melanocyte-stimulating hormone (α-MSH), β-endorphin, neurotensin, and oxytocin] and inflammatory cytokines levels were measured in basal tears. The link between neuropeptides and clinical parameters was investigated using Spearman rank correlation. RESULTS Overall, 76.3% of patients in the DED group showed dry eye symptoms and signs that were inconsistent in severity. Compared with the control group, the DED group showed higher levels of SP, α-MSH, and oxytocin in tears (P = 0.012, P = 0.030, and P = 0.006, respectively), but similar levels of β-endorphin and neurotensin (P = 0.269 and P = 0.052). The levels of SP, α-MSH, and oxytocin were elevated in DED patients with higher grading of symptoms than clinical signs (all P < 0.05). SP, α-MSH, and oxytocin levels in tears were positively correlated with Ocular Surface Disease Index scores, frequency of sensitivity to light, and frequency of blurred vision (all P < 0.05). CONCLUSIONS The increased tear levels of SP, α-MSH, and oxytocin may be linked to ocular discomfort in DED. Neuropeptides may play a key role in the development of DED, especially in DED patients with more severe symptoms than clinical signs.
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Sanchez V, Baksh BS, Cabrera K, Choudhury A, Jensen K, Klimas N, Galor A. Dry Eye Symptoms and Signs in US Veterans With Gulf War Illness. Am J Ophthalmol 2022; 237:32-40. [PMID: 34780800 PMCID: PMC9035031 DOI: 10.1016/j.ajo.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI). DESIGN Prospective cross-sectional study. METHODS We performed a prospective, cross-sectional study of South Florida veterans who were active duty during the Gulf War era (GWE; 1990-1991) and seen at an eye clinic between October 1, 2020, and March 13, 2021. Veterans were split into 2 groups: those who met Kansas criteria for GWI (cases, n = 30) and those who did not (controls, n = 41). DE symptoms were assessed via standardized questionnaires whereas DE signs were assessed using a series of ocular surface parameters. Differences between groups were assessed via Mann-Whitney U test. Linear regression analyses were used to examine which GWI symptoms most closely aligned with DE symptoms. RESULTS Veterans with GWI had higher DE symptoms scores compared to controls (Ocular Surface Disease Index [OSDI] scores: mean 41.20±22.92 vs 27.99±24.03, P = .01). In addition, veterans with GWI had higher eye pain scores compared with controls (average eye pain over past week: 2.63±2.72 vs 1.22±1.50, P = .03), including on neuropathic ocular pain questionnaires (Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 17.33±17.20 vs 9.63±12.64, P = .03). DE signs were mostly similar between the groups. GWI symptoms "nausea or upset stomach" (β=14.58, SE = 3.02, P < .001) and "headache" (β=7.90, SE = 2.91, P = .011) correlated with higher OSDI scores. CONCLUSION Individuals with GWI have more severe DE symptoms and ocular pain scores but similar tear and ocular surface parameters compared to controls without GWI. This finding suggests that mechanisms beyond tear dysfunction drive eye symptoms in GWI.
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Affiliation(s)
- Victor Sanchez
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Brandon S Baksh
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Kimberly Cabrera
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anjalee Choudhury
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Katherine Jensen
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Nancy Klimas
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA
| | - Anat Galor
- From the New York University Grossman School of Medicine (V.S.), New York, New York; University of Miami Miller School of Medicine (B.S.B., A.C., N.K., A.G.), Miami, Florida; Ophthalmology, Miami Veterans Affairs Medical Center (K.C.), Miami, Florida; and Bascom Palmer Eye Institute, University of Miami (A.C., A.G.), Miami, Florida, USA..
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Abstract
Dry eye disease (DED) is a major public health problem worldwide that seriously impairs the quality of life, reduces work productivity, and poses significant economic burden. In DED, tear film instability or hyperosmolarity activates a self-perpetuating vicious cycle that may aggravate ocular surface inflammation and damage. Thus, treatment approaches should focus on interrupting this cycle and ameliorating inflammation. In addition to anti-inflammatory medications, such as corticosteroids, cyclosporine, and lifitegrast, nutrients with anti-inflammatory and anti-oxidative properties may also be effective for the treatment of DED. Evidence indicates that vitamin deficiencies may be associated with an increased risk of DED and that vitamin supplementation can be an effective treatment for DED. In the present review, we introduce the results of clinical and experimental studies on the association between vitamin deficiencies and DED. The potential efficacy of systemic and topical supplementation in the treatment of DED is also discussed.
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Bereiter DA, Rahman M, Ahmed F, Thompson R, Luong N, Olson JK. Title: P2x7 Receptor Activation and Estrogen Status Drive Neuroinflammatory Mechanisms in a Rat Model for Dry Eye. Front Pharmacol 2022; 13:827244. [PMID: 35479310 PMCID: PMC9037241 DOI: 10.3389/fphar.2022.827244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/16/2022] [Indexed: 11/30/2022] Open
Abstract
Dry eye disease (DED) is recognized as a chronic inflammatory condition with an increase in tear osmolarity and loss of tear film integrity. DED is often accompanied by adverse ocular symptoms which are more prevalent in females than males. The basis for ocular hyperalgesia in DED remains uncertain; however, both peripheral and central neural mechanisms are implicated. A model for aqueous deficient DED, exorbital gland excision, was used to determine if activation of the purinergic receptor subtype 7, P2X7R, expressed by non-neural cells in peripheral and central trigeminal nerve pathways, contributed to persistent ocular hyperalgesia. Densitometry of trigeminal brainstem sections revealed increases in P2X7R, the myeloid cell marker Iba1, and the inflammasome, NLRP3, of estradiol-treated DED females compared to estradiol-treated sham females, while expression in DED males and DED females not given estradiol displayed minor changes. No evidence of immune cell infiltration into the trigeminal brainstem was seen in DED rats; however, markers for microglia activation (Iba1) were increased in all groups. Isolated microglia expressed increased levels of P2X7R and P2X4R, IL-1β (Ιnterleukin-1β), NLRP3, and iNOS (nitric oxide synthase). Further, estradiol-treated DED females displayed greater increases in P2X7R, IL-1β and NLRP3 expression compared to untreated DED females. Orbicularis oculi muscle activity (OOemg) evoked by ocular instillation of hypertonic saline (HS) was recorded as a surrogate measure of ocular hyperalgesia and was markedly enhanced in all DED groups compared to sham rats. Systemic minocycline reduced HS-evoked OOemg in all DED groups compared to sham rats. Local microinjection in the caudal trigeminal brainstem of an antagonist for P2X7R (A804598) greatly reduced HS-evoked OOemg activity in all DE groups, while responses in sham groups were not affected. Intra-trigeminal ganglion injection of siRNA for P2X7R significantly reduced HS-evoked OOemg activity in all DED groups, while evoked responses in sham animals were not affected. These results indicated that activation of P2X7R at central and peripheral sites in trigeminal pain pathways contributed to an increase in ocular hyperalgesia and microglia activation in DED males and females. Estrogen treatment in females further amplified ocular hyperalgesia and neuroimmune responses in this model for aqueous deficient DED.
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Affiliation(s)
- David A Bereiter
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Mostafeezur Rahman
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Fabeeha Ahmed
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Randall Thompson
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Nhungoc Luong
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
| | - Julie K Olson
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
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Corneal Confocal Microscopy Features and Tear Molecular Profile in Study Participants with Discordance between Ocular Surface Disease Clinical Signs and Discomfort. J Clin Med 2022; 11:jcm11092407. [PMID: 35566533 PMCID: PMC9099769 DOI: 10.3390/jcm11092407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/11/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
Various ocular surface conditions such as dry eye disease can present with severe discomfort and pain. However, it is clinically challenging to establish etiology and prescribe correct treatment in patients who have a lot of discordance between symptoms and signs. To understand the basis of such discordance, we stratified subjects with ocular surface pain based on concordance between the severity of signs and symptoms and evaluated corneal structural features and tear molecular factors. All subjects underwent slit lamp examination, dry eye evaluation, and ocular surface disease index (OSDI) scoring. Subjects were stratified into group 1—without symptoms or clinical signs; group 2—without symptoms but with signs; group 3—with similar severity of symptoms and signs; and group 4—with symptom severity greater than that of the signs. Laser scanning in vivo confocal microscopy (IVCM) and tear fluid analysis for soluble factors by multiplex ELISA was performed for all subjects. Patients with a higher grade of symptoms and signs showed increased corneal dendritic cell (cDC) density (p < 0.05) which was more pronounced in subjects with discordance between the symptoms and signs (group 4). A significantly higher proportion of microneuroma-like structures and cDC were observed in group 4. IL-17A levels were significantly elevated in the tears of subjects with more discomfort. Our results demonstrate that corneal IVCM and the measurement of tear film factors can help clinicians improve diagnosis and treatment choice. Stratifying patients with ocular surface discomfort on the basis of discordance between symptoms and clinical signs may help identify patients who need additional adjunctive targeted therapy to resolve their condition.
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41
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Inflammation-related molecules in tears of patients with chronic ocular pain and dry eye disease. Exp Eye Res 2022; 219:109057. [DOI: 10.1016/j.exer.2022.109057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 12/28/2022]
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Wu Y, Mou Y, Zhang Y, Han Y, Lin L, Huo Y, Zhu Y, Yang S, Huang X. Efficacy of Intense Pulsed Light Combined Blood Extract Eye Drops for Treatment of Nociceptive Pain in Dry Eye Patients. J Clin Med 2022; 11:jcm11051312. [PMID: 35268405 PMCID: PMC8910947 DOI: 10.3390/jcm11051312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To investigate the efficacy of intense pulsed light (IPL) combined with deproteinized calf blood extract (DCBE) eye drops for dry eye disease (DED) patients with nociceptive ocular pain. Methods: In this prospective, one-center, interventional study, 23 subjects with DED and ocular pain were treated with a combination of IPL and DCBE eye drops for four sessions at a four-week interval. Subjective and objective assessments on nociceptive pain and dry eye were examined and analyzed. Results: The visual analog scale (VAS), ocular surface disease index, ocular pain assessment survey (OPAS), patient health questionnaire-9 items, generalized anxiety disorder (GAD-7), Athens insomnia scale, corneal fluorescein staining score, meibomian gland secretion quality, and expressibility scores were significantly reduced after the treatment. Tear break-up time and Schirmer I test increased significantly. The brand density of corneal nerves and neuropeptide substance P also significantly increased. OPAS, GAD-7, meibomian gland secretion quality, and expressibility scores were essential factors affecting the VAS changes. Conclusions: IPL combined with DCBE drop therapy was effective for DED patients with ocular pain. With such treatment, both DED symptoms and the sensation of ocular pain may be improved.
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43
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The relationship between visual impairments and activity of the neck/shoulder muscles among surgeons during simulated surgical tasks. Surg Endosc 2022; 36:5326-5338. [PMID: 34997342 DOI: 10.1007/s00464-021-08913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Minimally Invasive Surgery (MIS) has an impact on surgeons' musculoskeletal and visual systems. However, the relationship between visual symptoms and musculoskeletal problems is not well understood. AIM OF THE STUDY This study used surface electromyography (sEMG) to examine changes in fatigue of the neck/shoulder muscles among surgeons with visual impairments when performing simulated surgical tasks in 2D and 3D viewing modes. DESIGN Cross-sectional laboratory study. METHODS Changes in median frequency (MDF, an indicator of muscle fatigue) were examined in 17 experienced gynaecologists. Four simulated surgical laparoscopy tasks were performed in 2D and 3D viewing modes. The MDF of three neck/shoulder muscles (cervical erector spinae, [CES], upper trapezii [UT], and anterior deltoids [AD]) were examined bilaterally. Visual parameters (accommodation, convergence, and stereoacuity) were measured prior to commencement. RESULTS There was a downward shift of MDF from simple to more complex tasks for the right and left CES and AD muscles but not the UT, which was consistent for surgeons with mild accommodation/convergence impairment and/or good stereoacuity. There were significant differences in the level of muscle fatigue of the neck/shoulder muscles according to the severity of visual impairment, muscle side, task and surgical performance level. CONCLUSIONS The results show a relationship between the degree of visual impairments and muscle fatigue of the neck/shoulder muscles among MIS surgeons. These findings have important implications in understanding the concurrence of musculoskeletal problems and visual symptoms.
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Tei Y, Mikami Y, Ito M, Tomida T, Ohshima D, Hori Y, Adachi-Akahane S. Pathogenic Mechanism of Dry Eye-Induced Chronic Ocular Pain and a Mechanism-Based Therapeutic Approach. Invest Ophthalmol Vis Sci 2022; 63:7. [PMID: 34989761 PMCID: PMC8742529 DOI: 10.1167/iovs.63.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Dry eye–induced chronic ocular pain is also called ocular neuropathic pain. However, details of the pathogenic mechanism remain unknown. The purpose of this study was to elucidate the pathogenic mechanism of dry eye–induced chronic pain in the anterior eye area and develop a pathophysiology-based therapeutic strategy. Methods We used a rat dry eye model with lacrimal gland excision (LGE) to elucidate the pathogenic mechanism of ocular neuropathic pain. Corneal epithelial damage, hypersensitivity, and hyperalgesia were evaluated on the LGE side and compared with the sham surgery side. We analyzed neuronal activity, microglial and astrocytic activity, α2δ–1 subunit expression, and inhibitory interneurons in the trigeminal nucleus. We also evaluated the therapeutic effects of ophthalmic treatment and chronic pregabalin administration on dry eye–induced ocular neuropathic pain. Results Dry eye caused hypersensitivity and hyperalgesia on the LGE side. In the trigeminal nucleus of the LGE side, neuronal hyperactivation, transient activation of microglia, persistent activation of astrocytes, α2δ–1 subunit upregulation, and reduced numbers of inhibitory interneurons were observed. Ophthalmic treatment alone did not improve hyperalgesia. In contrast, continuous treatment with pregabalin effectively ameliorated hypersensitivity and hyperalgesia and normalized neural activity, α2δ–1 subunit upregulation, and astrocyte activation. Conclusions These results suggest that dry eye–induced hypersensitivity and hyperalgesia are caused by central sensitization in the trigeminal nucleus with upregulation of the α2δ–1 subunit. Here, we showed that pregabalin is effective for treating dry eye–induced ocular neuropathic pain even after chronic pain has been established.
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Affiliation(s)
- Yuto Tei
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Faculty of Medicine, Toho University, Tokyo, Japan.,Department of Physiology, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Yoshinori Mikami
- Department of Physiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Masanori Ito
- Department of Physiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Taichiro Tomida
- Department of Physiology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Physiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Daisuke Ohshima
- Department of Physiology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Satomi Adachi-Akahane
- Department of Physiology, Toho University Graduate School of Medicine, Tokyo, Japan.,Department of Physiology, Faculty of Medicine, Toho University, Tokyo, Japan
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Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Immunity and pain in the eye: focus on the ocular surface. Clin Exp Immunol 2021; 207:149-163. [PMID: 35020868 PMCID: PMC8982975 DOI: 10.1093/cei/uxab032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/21/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023] Open
Abstract
Most ocular diseases are associated with pain. While pain has been generally considered a mere (deleterious) additional symptom, it is now emerging that it is a key modulator of innate/adaptive immunity. Because the cornea receives the highest nerve density of the entire body, it is an ideal site to demonstrate interactions between pain and the immune response. Indeed, most neuropeptides involved in pain generation are also potent regulators of innate and adaptive leukocyte physiology. On the other hand, most inflammatory cells can modulate the generation of ocular pain through release of specific mediators (cytokines, chemokines, growth factors, and lipid mediators). This review will discuss the reciprocal role(s) of ocular surface (and specifically: corneal) pain on the immune response of the eye. Finally, we will discuss the clinical implications of such reciprocal interactions in the context of highly prevalent corneal diseases.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Bonelli
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy,Correspondence: Giulio Ferrari, Cornea and Ocular Surface Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy. E-mail:
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46
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Scuteri D, Rombolà L, Hamamura K, Sakurada T, Watanabe C, Sakurada S, Guida F, Boccella S, Maione S, Gallo Afflitto G, Nucci C, Tonin P, Bagetta G, Corasaniti MT. Is there a rational basis for cannabinoids research and development in ocular pain therapy? A systematic review of preclinical evidence. Biomed Pharmacother 2021; 146:112505. [PMID: 34891121 DOI: 10.1016/j.biopha.2021.112505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment. METHODS Literature search includes the most relevant repositories for medical scientific literature from inception until November, 24 2021. Data collection and selection of retrieved records adhere to PRISMA criteria. RESULTS In agreement with a priori established protocol the search retrieved 2471 records leaving 479 results after duplicates removal. Eleven records result from title and abstract screening to meet the inclusion criteria; only 4 results are eligible for inclusion in the qualitative synthesis impeding meta-analysis. The qualitative analysis highlights the antinociceptive and anti-inflammatory efficacy of Δ8-tetrahydrocannabinol, cannabidiol and its derivative HU-308 and of new racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229. Moreover, CB2R agonists RO6871304 and RO6871085 and CB2R ligand HU910 provide evidence of anti-inflammatory efficacy. CB2 agonist HU308 reduces of 241% uveitis-induced leukocyte adhesion and changes lipidome profile. Methodological and design issues raise concern of risk of bias and the amount of studies is too small for generalization. Furthermore, the ocular pain model used can resemble only inflammatory but not neuropathic pain. CONCLUSIONS The role of the endocannabinoid system in ocular pain is underinvestigated, since only two studies assessing the effects of cannabinoid receptors modulators on pain behavior and other two on pain-related inflammatory processes are found. Preclinical studies investigating the efficacy of cannabinoids in ocular inflammatory and neuropathic pain models are needed to pave the way for clinical translation.
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Affiliation(s)
- D Scuteri
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy; Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - L Rombolà
- Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
| | - K Hamamura
- Department of Pharmacology, Daiichi University of Pharmacy, 815-8511 Fukuoka, Japan.
| | - T Sakurada
- Department of Pharmacology, Daiichi University of Pharmacy, 815-8511 Fukuoka, Japan.
| | - C Watanabe
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 981-8558 Sendai, Japan.
| | - S Sakurada
- Department of Physiology and Anatomy, Tohoku Pharmaceutical University, 981-8558 Sendai, Japan.
| | - F Guida
- Department of Experimental Medicine, Pharmacology Division, University of Campania "L. Vanvitelli", 80138 Naples, Italy.
| | - S Boccella
- Department of Experimental Medicine, Pharmacology Division, University of Campania "L. Vanvitelli", 80138 Naples, Italy.
| | - S Maione
- Department of Experimental Medicine, Pharmacology Division, University of Campania "L. Vanvitelli", 80138 Naples, Italy; Endocannabinoid Research Group, Institute of Biomolecular Chemistry, CNR, Pozzuoli, Italy; IRCSS, Neuromed, Pozzilli, Italy.
| | - G Gallo Afflitto
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - C Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy.
| | - P Tonin
- Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
| | - G Bagetta
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - M T Corasaniti
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, 88100 Catanzaro, Italy.
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Tong L, Lim L, Tan D, Heng WJ, Lim J, Chan C, Arundhati A, Tan A. Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework. Asia Pac J Ophthalmol (Phila) 2021; 10:530-541. [PMID: 34759232 PMCID: PMC8673856 DOI: 10.1097/apo.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup.This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented.Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened.We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.
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Affiliation(s)
- Louis Tong
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Li Lim
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Donald Tan
- Yong Loo Lin School of Medicine, Singapore
- Eye Retina Surgeon, Singapore
| | - Wee Jin Heng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | | | - Anshu Arundhati
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Anna Tan
- Department of Ophthalmology, National University Hospital, Singapore
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Guerrero-Moreno A, Liang H, Moreau N, Luzu J, Rabut G, Melik Parsadaniantz S, Labbé A, Baudouin C, Réaux-Le Goazigo A. Corneal Nerve Abnormalities in Painful Dry Eye Disease Patients. Biomedicines 2021; 9:biomedicines9101424. [PMID: 34680542 PMCID: PMC8533181 DOI: 10.3390/biomedicines9101424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background: This study aimed to compare the corneal nerve structural abnormalities detected using in vivo confocal microscopy (IVCM) in patients with neuropathic corneal pain (NCP) secondary to primary meibomian gland dysfunction (MGD) or autoimmune dry eye (AIDE). Methods: A two-stage retrospective nested case-control study was conducted. First, data from patients with either MGD or AIDE were assessed, selecting only cases with no corneal pain (VAS = 0) or severe pain (VAS ≥ 8). Ocular signs and symptoms of the 238 selected patients were compared between painful and painless cases. Next, painful patients with no corneal damage (Oxford score ≤ 1) were selected within each study group, defining the cases with NCP (i.e., "pain without stain"). IVCM images from all groups were compared with prospectively-recruited healthy controls, focusing on dendritiform cell density and nerve abnormalities (density, tortuosity, microneuromas). Results: AIDE patients had more ocular signs/symptoms than MGD patients. Compared with healthy controls, AIDE-related NCP patients showed increased nerve tortuosity and number of neuromas, whereas MGD-related NCP patients had reduced nerve density and increased number, perimeter, and area of microneuromas. Microneuromas were also observed in healthy controls. Furthermore, a higher number of microneuromas was found in MGD-related NCP compared to AIDE-related NCP or painless MGD. Conclusions: MGD-related NCP was associated with significantly more corneal nerve abnormalities than AIDE-related NCP or healthy controls. Although IVCM can be useful to detect NCP-related corneal nerve changes in such patients, the diagnosis of dry eye disease-related NCP will require an association of several IVCM-based criteria without relying solely on the presence of microneuromas.
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Affiliation(s)
- Adrian Guerrero-Moreno
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
| | - Hong Liang
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 17 rue Moreau, 75012 Paris, France; (J.L.); (G.R.); (A.L.)
| | - Nathan Moreau
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
| | - Jade Luzu
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 17 rue Moreau, 75012 Paris, France; (J.L.); (G.R.); (A.L.)
| | - Ghislaine Rabut
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 17 rue Moreau, 75012 Paris, France; (J.L.); (G.R.); (A.L.)
| | - Stéphane Melik Parsadaniantz
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
| | - Antoine Labbé
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 17 rue Moreau, 75012 Paris, France; (J.L.); (G.R.); (A.L.)
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Christophe Baudouin
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
- CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 17 rue Moreau, 75012 Paris, France; (J.L.); (G.R.); (A.L.)
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Annabelle Réaux-Le Goazigo
- Institut de la Vision, INSERM, CNRS, Sorbonne Université, 17 rue Moreau, 75012 Paris, France; (A.G.-M.); (H.L.); (N.M.); (S.M.P.); (C.B.)
- Correspondence: ; Tel.: +33-153462572
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Yavuz Saricay L, Bayraktutar BN, Kenyon BM, Hamrah P. Concurrent ocular pain in patients with neurotrophic keratopathy. Ocul Surf 2021; 22:143-151. [PMID: 34411735 DOI: 10.1016/j.jtos.2021.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To illustrate that ocular pain may occur in patients with neurotrophic keratopathy (NK) that typically are thought to lack symptoms of discomfort, and that aa subset of these patients may also present with neuropathic corneal pain (NCP). METHOD Retrospective Case series of 7 stage 1 NK patients who presented with concurrent ocular pain, as confirmed by clinical examination, proparacaine challenge test, and in vivo corneal confocal microscopy (IVCM). Records were assessed for results of ocular surface disease index (OSDI), pain on visual analog scale (VAS), ocular pain assessment survey (OPAS), best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, and IVCM findings. IVCM findings were compared to that of 20 healthy reference controls. RESULTS Mean age of patients was 63.7 ± 11.6 (range 44-76) years and 56.9 ± 8.6 (range 42-74) years in reference controls (p = 0.11). At presentation, ocular discomfort was 8.0 ± 1.3 (range 7-10) on VAS and mean OSDI scores were 72.26 ± 6.81 (range 62.50-79.54). Mean BCVA was 20/40, and mean CFS scores were 3.43 ± 0.79 (range 2-4) on the Oxford scale. IVCM analysis showed significant decrease in mean total, main and branch nerve densities in ranges consistent with NK as compared to normal controls (p < 0.001 for all), increased dendritiform cell density in three patients (p < 0.001), and the presence of microneuromas in six of the patients. CONCLUSION Patients with NK are thought to present with hypoesthesia. However, nerve damage and inflammation, which play a role in the development of NK may result in the development of chronic ocular pain, such as NCP, resulting in potential underdiagnosis of either disease.
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Affiliation(s)
- Leyla Yavuz Saricay
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical School, Tufts Medical Center School of Medicine, Boston, USA
| | - Betul N Bayraktutar
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical School, Tufts Medical Center School of Medicine, Boston, USA
| | - Brendan M Kenyon
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA; Program in Neuroscience, School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical School, Tufts Medical Center School of Medicine, Boston, USA; Program in Neuroscience, School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA; Department of Neuroscience, Tufts University School of Medicine, Boston, MA, USA.
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50
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Master A, Kontzias A, Huang L, Huang W, Tsioulias A, Zarabi S, Wolek M, Wollocko BM, Honkanen R, Rigas B. The transcriptome of rabbit conjunctiva in dry eye disease: Large-scale changes and similarity to the human dry eye. PLoS One 2021; 16:e0254036. [PMID: 34324523 PMCID: PMC8321226 DOI: 10.1371/journal.pone.0254036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/31/2023] Open
Abstract
The pathophysiology of dry eye disease (DED) remains largely unknown, accounting in part for the lack of successful treatments. We explored the pathophysiology of DED using a rabbit model of chronic DED induced with 3 weekly injections of Concanavalin A into the periorbital lacrimal glands. The transcriptome of full-thickness's conjunctival tissue from rabbits with DED and from normal controls was determined using microarrays and, as needed, confirmatory real-time polymerase chain reactions. Results were subjected to bioinformatic analysis. DED induced large-scale changes in gene transcription involving 5,184 genes (22% of the total). Differentially expressed genes could be segregated into: functional modules and clusters; altered pathways; functionally linked genes; and groups of individual genes of known or suspected pathophysiological relevance to DED. A common feature of these subgroups is the breadth and magnitude of the changes that encompass ocular immunology and essentially all aspects of cell biology. Prominent changes concerned innate and adaptive immune responses; ocular surface inflammation; at least 25 significantly altered signaling pathways; a large number of chemokines; cell cycle; and apoptosis. Comparison of our findings to the limited extant transcriptomic data from DED patients associated with either Sjogren's syndrome or non-Sjogren's etiologies revealed a significant correlation between human and rabbit DED transcriptomes. Our data, establishing the large-scale transcriptomic changes of DED and their potential similarity to the human, underscore the enormous complexity of DED; establish a robust animal model of DED; will help expand our understanding of its pathophysiology; and could guide the development of successful therapeutic strategies.
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Affiliation(s)
- Adam Master
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Apostolos Kontzias
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Liqun Huang
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
- Medicon Pharmaceuticals, Inc., Setauket, New York, United States of America
| | - Wei Huang
- Department of Ophthalmology, Stony Brook University, Stony Brook, New York, United States of America
| | - Anna Tsioulias
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Samaneh Zarabi
- Department of Pathology, Stony Brook University, Stony Brook, New York, United States of America
| | - Michael Wolek
- Renaissance Medical School, Stony Brook University, Stony Brook, New York, United States of America
| | - Brian M. Wollocko
- Renaissance Medical School, Stony Brook University, Stony Brook, New York, United States of America
| | - Robert Honkanen
- Department of Ophthalmology, Stony Brook University, Stony Brook, New York, United States of America
| | - Basil Rigas
- Department of Preventive Medicine, Stony Brook University, Stony Brook, New York, United States of America
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