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Alotaibi S, Papas E, Mobeen R, Ozkan J, Misra SL, Markoulli M. Tear film hTERT and corneal nerve characteristics in dry eye disease. Clin Exp Optom 2024:1-6. [PMID: 38755754 DOI: 10.1080/08164622.2024.2354775] [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: 12/09/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
CLINICAL RELEVANCE The behaviour of human telomerase reverse transcriptase (hTERT) in tears reflects its role in maintaining the ocular surface homoeostasis, as it is increased after the initial fitting of contact lenses and post-overnight lid closure. BACKGROUND hTERT has been shown to respond to cellular stress in neurodegenerative diseases and to enhance axonal regeneration after peripheral axotomy in an animal model. This work investigated whether the behaviour of hTERT in the tear film reflects ocular surface inflammation and neuronal changes in the presence of dry eye disease. METHODS Flush tears were collected from 18 participants with dry eye disease (14 females, 4 males, mean age 34.7 ± 5.2 years) and from 18 healthy participants without dry eye disease (8 females, 10 males, mean age 31.9 ± 5.8 years). Dry eye disease status was defined using the TFOS DEWS II diagnostic criteria. hTERT levels in tears were measured using enzyme-linked immunosorbent assays. Confocal images were taken at the level of the subbasal nerve plexus at the central cornea and at the inferior whorl, and the densities of corneal immune cells were evaluated as well as corneal nerve morphology metrics using a fully automated technique (University of Manchester, United Kingdom). RESULTS In participants with dry eye disease, hTERT levels were significantly higher compared to controls (median [interquartile range]: 434 [320-600] ng/ml, and 184 [42-390] ng/ml, respectively, p = 0.01). Increased nerve fibre width at the inferior whorl, was seen in those with dry eyes (0.0219 [0.0214-0.0236] mm/mm compared to controls 0.0217 [0.0207 0.0222] p < 0.001), but no significant differences were found in the density of corneal immune cells. CONCLUSIONS hTERT levels were elevated in participants with dry eye disease, and this was accompanied by increased nerve thickness in the inferior cornea. The hTERT response may reflect the stress induced to the ocular surface and corneal nerves due to having dry eye disease.
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Affiliation(s)
- Sultan Alotaibi
- Department of Optometry and Vision Science, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Eric Papas
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Rabia Mobeen
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Jerome Ozkan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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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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Ayoubi M, Cabrera K, Locatelli EVT, Felix ER, Galor A. Associations between Corneal Nerve Structure and Function in a Veteran Population. J Clin Med 2024; 13:2513. [PMID: 38731042 PMCID: PMC11084432 DOI: 10.3390/jcm13092513] [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: 03/29/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (β = -0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function.
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Affiliation(s)
- Mohammad Ayoubi
- Surgical and Research Services, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; (M.A.); (E.R.F.)
| | - Kimberly Cabrera
- Surgical and Research Services, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; (M.A.); (E.R.F.)
| | - Elyana VT Locatelli
- Surgical and Research Services, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; (M.A.); (E.R.F.)
| | - Elizabeth R. Felix
- Surgical and Research Services, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; (M.A.); (E.R.F.)
| | - Anat Galor
- Surgical and Research Services, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; (M.A.); (E.R.F.)
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
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Kantor NB, Tovar A, Wang T, Galor A. How does ocular graft-versus-host disease fit under the dry eye umbrella? A review. Clin Exp Ophthalmol 2024; 52:167-185. [PMID: 38204146 PMCID: PMC10939887 DOI: 10.1111/ceo.14347] [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: 10/07/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Graft-versus-host disease (GVHD) is a systemic disease that can affect multiple organs as a consequence of an allogeneic haematopoietic stem cell transplant. One organ system that is often affected in GVHD is the eyes. Ocular GVHD (oGVHD) may involve various structures within the eye including the lacrimal glands, eyelids, conjunctiva, cornea, and nasolacrimal ducts, and is a source of morbidity in patients with GVHD. Common presenting features of GVHD overlap with dry eye disease (DED), including decreased tear production, epithelial disruption, and Meibomian gland dysfunction (MGD). In this review, we aim to compare oGVHD and DED to better understand the similarities and differences between the conditions, with a focus on pathophysiology, risk factors, clinical features, and treatments.
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Affiliation(s)
- Nicole B. Kantor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | | | - Trent Wang
- Division of Transplantation and Cellular Therapy, Sylvester Comprehensive Cancer Center, Adult Stem Cell Transplant Program, University of Miami Hospital and Clinics, Miami, FL, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Chen Q, Wang L, Zhang Y, Xu X, Wei Z, Zhang Z, Wei Y, Pang J, Guo X, Cao K, Liang Q. Corneal Epithelial Dendritic Cells: An Objective Indicator for Ocular Surface Inflammation in Patients with Obstructive Meibomian Gland Dysfunction? Ocul Immunol Inflamm 2024; 32:79-88. [PMID: 36622888 DOI: 10.1080/09273948.2022.2155843] [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: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE To examine whether corneal epithelial dendritic cells (CEDC) could serve as an indicator to distinguish obstructive meibomian gland dysfunction (MGD) with or without ocular surface inflammation (OSI). METHODS We performed a case-control study on patients with diagnosed obstructive MGD between August 2017 and November 2019. RESULTS 30 MGD cases and 25 healthy controls were recruited. The classification of MGD patients with and without OSI was based on the tear pro-inflammatory cytokine levels. Compared with the MGD without OSI and the control group, a higher CEDC density was detected in the MGD with OSI subgroup. The presence of >15.6 cells/mm2 CEDC had a sensitivity of 73% and specificity of 75% for the diagnosis of MGD with OSI. CONCLUSIONS OSI is not present in all patients with obstructive MGD. Evaluation of CEDC density in the central cornea may help identify whether MGD is concomitant with OSI.
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Affiliation(s)
- Qiankun Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Leying Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yuheng Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xizhan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhenyu Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zijun Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yuan Wei
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Jinding Pang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xiaoyan Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Qingfeng Liang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Mercado C, Muñoz-Ortiz J, Godin F, Galor A. Confocal Microscopy Abnormalities Preceding Antibody Positivity and Manifestations of Sjogren's Syndrome. Ocul Immunol Inflamm 2023; 31:1741-1745. [PMID: 35914299 PMCID: PMC9889574 DOI: 10.1080/09273948.2022.2103713] [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: 11/22/2021] [Accepted: 07/14/2022] [Indexed: 02/03/2023]
Abstract
An asymptomatic 26-year-old woman underwent confocal microscopy as part of a control population for a research study. Images revealed reduced sub-basal corneal nerve density and multiple activated dendritic cells. Three years later, she presented with a self-limited cutaneous vasculitis in her lower extremities which prompted an evaluation for autoimmune diseases. Laboratory testing revealed positive antinuclear antibodies (1:320, thick granular pattern), and anti-SSA/SSB (SSA, 53.6 U/mL, moderately positive; SSB, 142.7 U/mL, strongly positive). Two weeks later, she presented with ocular pain and an ophthalmologic examination revealed ocular surface staining. An ocular ultrasound was consistent with posterior scleritis. Based on this picture, a diagnosis of Sjögren syndrome (SS) was made. SS is a chronic autoimmune disease that can present with symptoms that diminish the patient's quality of life. Confocal microscopy might be a valuable tool for the early diagnosis of disease.
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Affiliation(s)
- Carolina Mercado
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Juliana Muñoz-Ortiz
- Escuela Superior de Oftalmología, Instituto Barraquer de América, Bogotá, Colombia
| | - Fernando Godin
- Department of Ophthalmology, Universidad El Bosque. Bogotá, Colombia
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
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Patel S, Mittal R, Kumar N, Galor A. The environment and dry eye-manifestations, mechanisms, and more. FRONTIERS IN TOXICOLOGY 2023; 5:1173683. [PMID: 37681211 PMCID: PMC10482047 DOI: 10.3389/ftox.2023.1173683] [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: 05/17/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial condition that often presents with chronic symptoms of pain (that can be characterized as "dryness," "burning," and "irritation," to name a few) and/or fluctuating or poor-quality vision. Given its multifactorial nature, several pathophysiologic mechanisms have been identified that can underlie symptoms, including tear film, ocular surface, and/or corneal somatosensory nerve abnormalities. Research has focused on understanding how environmental exposures can increase the risk for DED flares and negatively impact the tear film, the ocular surface, and/or nerve health. Given that DED is a common condition that negatively impacts physical and mental functioning, managing DED requires multiple strategies. These can include both medical approaches and modulating adverse environmental conditions, the latter of which may be a cost-effective way to avoid DED flares. Thus, an understanding of how environmental exposures relate to disease is important. This Review summarizes research on the relationships between environmental exposures and DED, in the hope that this information will engage healthcare professionals and patients to consider environmental manipulations in their management of DED.
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Affiliation(s)
- Sneh Patel
- Division of Physical Medicine and Rehabilitation, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- University of California Los Angeles (UCLA), Los Angeles, CA, United States
| | - Rhiya Mittal
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Naresh Kumar
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
- Ophthalmology and Research Services, Miami VA Medical Center, Miami, FL, United States
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Levine H, Tovar A, Cohen AK, Cabrera K, Locatelli E, Galor A, Feuer W, O'Brien R, Goldhagen BE. Automated identification and quantification of activated dendritic cells in central cornea using artificial intelligence. Ocul Surf 2023; 29:480-485. [PMID: 37385344 DOI: 10.1016/j.jtos.2023.06.001] [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: 09/13/2022] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To validate an algorithm quantifying activated dendritic cells (aDCs) using in-vivo confocal microscopy (IVCM) images. METHODS IVCM images obtained at the Miami Veterans Affairs Hospital were retrospectively analyzed. ADCs were quantified both with an automated algorithm and manually. Intra-class-correlation (ICC) and a Bland-Altman plot were used to compare automated and manual counts. As a secondary analysis, individuals were grouped by Dry Eye (DE) subtype: 1) aqueous-tear deficiency (ATD; Schirmer's test ≤5 mm); 2) evaporative DE (EDE; TBUT≤5s); or 3) control (Schirmer's test>5 mm; TBUT>5s) and ICCs were re-examined. RESULTS 173 non-overlapping images from 86 individuals were included in this study. The mean age was 55.2 ± 16.7 years; 77.9% were male; 20 had ATD; 18 EDE and 37 were controls. The mean number of aDCs in the central cornea quantified automatically was 0.83 ± 1.33 cells/image and manually was 1.03 ± 1.65 cells/image. A total of 143 aDCs were identified by the automated algorithm and 178 aDCs were identified manually. While a Bland-Altman plot indicated a small difference between the two methods (0.19, p < 0.01), the ICC of 0.80 (p = 0.01) demonstrated excellent agreement. Secondarily, similar results were found by DE type with an ICC of 0.75 (p = 0.01) for the ATD group, 0.80 (p = 0.01) for EDE, and 0.82 (p = 0.01) for controls. CONCLUSIONS Quantification of aDCs within the central cornea may be successfully estimated using an automated machine learning based algorithm. While this study suggests that analysis using artificial intelligence has comparable results with manual quantification, further longitudinal research to validate our findings in more diverse populations may be warranted.
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Affiliation(s)
- Harry Levine
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - Arianna Tovar
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - Adam K Cohen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - Kimberly Cabrera
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - Elyana Locatelli
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Robert O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Brian E Goldhagen
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, 33136, USA; Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA.
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Sanchez V, Cohen NK, Felix E, Galor A. Factors affecting the prevalence, severity, and characteristics of ocular surface pain. EXPERT REVIEW OF OPHTHALMOLOGY 2022; 18:19-32. [PMID: 37009062 PMCID: PMC10062703 DOI: 10.1080/17469899.2023.2157813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Introduction Ocular surface pain has been traditionally lumped under the umbrella term "dry eye" (DE) but is now understood as its own entity and can occur in the absence or presence of tear dysfunction. Identifying patients at risk for the development of chronic ocular surface pain, and factors contributing to its severity are important in providing precision medicine to patients. Areas covered In this review, we discuss factors linked to the presence and severity of ocular surface pain, including eye related features, systemic characteristics, and environmental findings. We discuss corneal nerves, whose anatomic and functional integrity can be characterized through in vivo confocal microscopy images and testing of corneal sensitivity. We review systemic diseases that are co-morbid with ocular surface pain, including physical and mental health diagnoses. Finally, we identify environmental contributors, including air pollution, previous surgeries, and medications, associated with ocular surface pain. Expert opinion Intrinsic and extrinsic factors contribute to ocular surface pain and must be considered when evaluating an individual patient. These factors can inform the suspected etiology of the pain, and guide management decisions such as tear replacement or medications targeting nerve pain.
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Affiliation(s)
- Victor Sanchez
- Department of Ophthalmology, New York University School of Medicine, 550 First Avenue, New York, NY 10016
| | - Noah K Cohen
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136
| | - Elizabeth Felix
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136
- Surgical services, Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL 33125
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136
- Surgical services, Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL 33125
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