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Indian Journal of Ophthalmology Sep 2020Scleritis is a rare painful ocular disorder, associated with severe ocular pain and tissue destruction. Although a majority of these cases are immune mediated and at... (Review)
Review
Scleritis is a rare painful ocular disorder, associated with severe ocular pain and tissue destruction. Although a majority of these cases are immune mediated and at least half of these are associated with systemic immune-mediated diseases, a smaller minority are due to infections of the sclera. The two conditions closely mimic each other, and a thorough knowledge of the subtle differences is necessary in order to reach a timely diagnosis. Diagnostic delay can lead to a poor outcome both due to the destruction caused by the uncontrolled infection and also due to propagation of the infection with the use of corticosteroids which may have been started for presumed immune mediated scleritis. In this review, we present the clinical features, etiological agents, and the differentiating features between immune and infectious scleritis. We also present diagnostic and management guidelines for managing scleral infection.
Topics: Adrenal Cortex Hormones; Delayed Diagnosis; Eye Pain; Humans; Sclera; Scleritis
PubMed: 32823398
DOI: 10.4103/ijo.IJO_2032_20 -
Ophthalmic & Physiological Optics : the... Nov 2017Blue-blocking (BB) spectacle lenses, which attenuate short-wavelength light, are being marketed to alleviate eyestrain and discomfort when using digital devices, improve... (Review)
Review
PURPOSE
Blue-blocking (BB) spectacle lenses, which attenuate short-wavelength light, are being marketed to alleviate eyestrain and discomfort when using digital devices, improve sleep quality and potentially confer protection from retinal phototoxicity. The aim of this review was to investigate the relative benefits and potential harms of these lenses.
METHODS
We included randomised controlled trials (RCTs), recruiting adults from the general population, which investigated the effect of BB spectacle lenses on visual performance, symptoms of eyestrain or eye fatigue, changes to macular integrity and subjective sleep quality. We searched MEDLINE, EMBASE, the Cochrane Library and clinical trial registers, until 30 April 2017. Risk of bias was assessed using the Cochrane tool.
RESULTS
Three studies (with 136 participants) met our inclusion criteria; these had limitations in study design and/or implementation. One study compared the effect of BB lenses with clear lenses on contrast sensitivity (CS) and colour vision (CV) using a pseudo-RCT crossover design; there was no observed difference between lens types (log CS; Mean Difference (MD) = -0.01 [-0.03, 0.01], CV total error score on 100-hue; MD = 1.30 [-7.84, 10.44]). Another study measured critical fusion frequency (CFF), as a proxy for eye fatigue, on wearers of low and high BB lenses, pre- and post- a two-hour computer task. There was no observed difference between low BB and standard lens groups, but there was a less negative change in CFF between the high and low BB groups (MD = 1.81 [0.57, 3.05]). Both studies compared eyestrain symptoms with Likert scales. There was no evidence of inter-group differences for either low BB (MD = 0.00 [-0.22, 0.22]) or high BB lenses (MD = -0.05 [-0.31, 0.21]), nor evidence of a difference in the proportion of participants showing an improvement in symptoms of eyestrain or eye fatigue. One study reported a small improvement in sleep quality in people with self-reported insomnia after wearing high compared to low-BB lenses (MD = 0.80 [0.17, 1.43]) using a 10-point Likert scale. A study involving normal participants found no observed difference in sleep quality. We found no studies investigating effects on macular structure or function.
CONCLUSIONS
We find a lack of high quality evidence to support using BB spectacle lenses for the general population to improve visual performance or sleep quality, alleviate eye fatigue or conserve macular health.
Topics: Circadian Rhythm; Contrast Sensitivity; Eye Pain; Eyeglasses; Humans; Light; Macula Lutea; Randomized Controlled Trials as Topic; Sleep; Sleep Initiation and Maintenance Disorders; Visual Acuity
PubMed: 29044670
DOI: 10.1111/opo.12406 -
Ocular Immunology and Inflammation Jul 2021: While cannabis has the potential to reduce corneal pain, cannabinoids might induce side effects. This review article examines the effects of cannabinoids on the... (Review)
Review
: While cannabis has the potential to reduce corneal pain, cannabinoids might induce side effects. This review article examines the effects of cannabinoids on the cornea. As more states and countries consider the legalization of adult cannabis use, health-care providers will need to identify ocular effects of cannabis consumption.: Studies included in this review examined the connection between cannabis and the cornea, more specifically anti-nociceptive and anti-inflammatory actions of cannabinoids. NCBI Databases from 1781 up to December 2019 were consulted.: Five studies examined corneal dysfunctions caused by cannabis consumption (opacification, decreased endothelial cell density). Twelve studies observed a reduction in corneal pain and inflammation (less lymphocytes, decreased corneal neovascularization, increased cell proliferation and migration).: More than half of the studies examined the therapeutic effects of cannabinoids on the cornea. As the field is still young, more studies should be conducted to develop safe cannabinoid treatments for corneal diseases.
Topics: Cannabis; Cornea; Corneal Endothelial Cell Loss; Corneal Neovascularization; Corneal Opacity; Eye Pain; Humans; Keratitis; Medical Marijuana
PubMed: 32159404
DOI: 10.1080/09273948.2020.1726969 -
The Ocular Surface Oct 2023To identify and assess the quality of current validated questionnaires that could be used to evaluate ocular neuropathic pain and its associated aetiologies. (Review)
Review
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.
Topics: Humans; Reproducibility of Results; Neuralgia; Dry Eye Syndromes; Sjogren's Syndrome; Refractive Surgical Procedures; Eye Pain; Surveys and Questionnaires
PubMed: 37748645
DOI: 10.1016/j.jtos.2023.09.009 -
Die Ophthalmologie Dec 2023Numerous conditions in the field of ophthalmology are associated with pain in or around the eye. Chronic pain associated with the eye is a common finding in the daily... (Review)
Review
Numerous conditions in the field of ophthalmology are associated with pain in or around the eye. Chronic pain associated with the eye is a common finding in the daily routine of ophthalmologists and can be associated with primary ocular or extraocular diseases as well as with other conditions. Appropriate diagnostic assessment and management of people with chronic pain requires an understanding of the condition based on the biopsychosocial model in which the interactions of biological/somatic, psychological and social factors are determining pain and suffering. Beyond the ophthalmological findings, close interdisciplinary cooperation and assessment are required. Therefore, if eye pain is insufficiently responsive to treatment or if symptoms of chronic pain are evident, pain medicine expertise should be involved. The management of chronic ocular pain is based on interdisciplinary multimodal approaches, in addition to the ophthalmologist-specific approaches. These focus on self-efficacy, patient competence and acceptance of pain as central goals of treatment rather than pain relief. Patient information, education and the development of a suitable concept by the interdisciplinary team are essential therapeutic aspects in this context.
Topics: Humans; Chronic Pain; Eye Pain; Eye; Pain Management
PubMed: 37999754
DOI: 10.1007/s00347-023-01957-8 -
Current Opinion in Allergy and Clinical... Oct 2023To review the pathophysiology and treatment of ocular itch and pain, encompassing nociceptive and neuropathic categories. (Review)
Review
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.
Topics: Humans; Quality of Life; Pruritus; Sensation; Eye; Neuralgia; Eye Pain
PubMed: 37490616
DOI: 10.1097/ACI.0000000000000934 -
European Journal of Ophthalmology May 2019To assess the feasibility of a novel surgical technique in painful blind eyes.
OBJECTIVE
To assess the feasibility of a novel surgical technique in painful blind eyes.
DESIGN
A prospective safety study conducted at the Federal University of Minas Gerais, Brazil.
PARTICIPANTS/SAMPLES
A total of 15 end-stage glaucomatous eyes without light perception vision.
METHODS
After implantation, conjunctival hyperemia, discharge, erosion, aqueous humor leakage, corneal edema, hyphema, anterior chamber cells and depth, dislocation of the implant, and filtering bleb height were assessed by slit-lamp biomicroscopy. Intraocular pressure was measured preoperatively and 24 months following surgery. A numerical rating scale was used to evaluate pain. Anterior segment optical coherence tomography was also assessed.
RESULTS
Laminar drainage implant surgery was performed in all patients without major complications. Mean intraocular pressure was significantly reduced after surgery without hypotensive medication (preoperatively 54.5 ± 5.1 mmHg vs 24 months after surgery 37.0 ± 15.4 mmHg, p = 0.003). Subjective ocular pain intensity also reduced (preoperatively 10 vs at 24-month follow-up visits 0). Corneal edema incidence reduced from 85.7% (95% confidence interval: 57.2%-98.2%) to 16.7% (95% confidence interval: 2.1%-48.4%) at the 24-month follow-up. No patients experienced a prolonged flat anterior chamber or erosion of overlying tissues.
CONCLUSION
The surgery was feasible and safe in painful blind eyes.
Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Aqueous Humor; Blindness; Corneal Edema; Eye Pain; Feasibility Studies; Female; Glaucoma; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Male; Middle Aged; Postoperative Complications; Prospective Studies; Prosthesis Implantation; Tomography, Optical Coherence; Tonometry, Ocular
PubMed: 30474392
DOI: 10.1177/1120672118815066 -
Ophthalmology Jul 2023To examine the frequency and risk factors for ocular pain after laser assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).
PURPOSE
To examine the frequency and risk factors for ocular pain after laser assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK).
DESIGN
Prospective study of individuals undergoing refractive surgery at 2 different centers.
PARTICIPANTS
One hundred nine individuals undergoing refractive surgery: 87% LASIK and 13% PRK.
METHODS
Participants rated ocular pain on a numerical rating scale (NRS) of 0 to 10 before surgery and 1 day, 3 months, and 6 months after surgery. A clinical examination focused on ocular surface health was performed 3 and 6 months after surgery. Persistent ocular pain was defined as an NRS score of 3 or more at both 3 and 6 months after surgery (patients), and this group was compared with individuals with NRS scores of < 3 at both time points (control participants).
MAIN OUTCOME MEASURES
Individuals with persistent ocular pain after refractive surgery.
RESULTS
The 109 patients who underwent refractive surgery were followed up for 6 months after surgery. Mean age was 34 ± 8 years (range, 23-57 years); 62% self-identified as female, 81% as White, and 33% as Hispanic. Eight patients (7%) reported ocular pain (NRS score ≥ 3) before surgery, with the frequency of ocular pain increasing after surgery to 23% (n = 25) at 3 months and 24% (n = 26) at 6 months. Twelve patients (11%) reported an NRS score of 3 or more at both time points and constituted the persistent pain group. Factors that predicted persistent pain after surgery in a multivariable analysis were (1) ocular pain before surgery predicated persistent pain after surgery (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.06-3.31), (2) symptom report of depression before surgery (Patient Health Questionnaire-9: OR, 1.3; 95% CI, 1.1-1.6; P = 0.01), (3) use of an oral antiallergy medication before surgery (OR, 13.6; 95% CI, 2.1-89.3; P = 0.007), and (4) pain intensity day 1 after surgery (OR, 1.6; 95% CI, 1.2-2.2; P = 0.005). There were no significant associations between ocular surface signs of tear dysfunction and ocular pain, P > 0.05 for all ocular surface signs. Most individuals (> 90%) were completely or somewhat satisfied with their vision at 3 and 6 months.
CONCLUSIONS
Eleven percent of individuals reported persistent ocular pain after refractive surgery, with several preoperative and perioperative factors predicting pain after surgery.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found after the references.
Topics: Humans; Female; Adult; Lasers, Excimer; Prospective Studies; Myopia; Photorefractive Keratectomy; Keratomileusis, Laser In Situ; Cornea; Pain; Eye Pain; Risk Factors; Refraction, Ocular
PubMed: 36809816
DOI: 10.1016/j.ophtha.2023.02.016 -
The British Journal of Ophthalmology Jan 2016As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional... (Review)
Review
As the biological alarm of impending or actual tissue damage, pain is essential for our survival. However, when it is initiated and/or sustained by dysfunctional elements in the nociceptive system, it is itself a disease known as neuropathic pain. While the critical nociceptive system provides a number of protective functions, it is unique in its central role of monitoring, preserving and restoring the optical tear film in the face of evaporative attrition without which our vision would be non-functional. Meeting this existential need resulted in the evolution of the highly complex, powerful and sensitive dry eye alarm system integrated in the peripheral and central trigeminal sensory network. The clinical consequences of corneal damage to these nociceptive pathways are determined by the type and location of its pathological elements and can range from the spectrum known as dry eye disease to the centalised oculofacial neuropathic pain syndrome characterised by a striking disparity between the high intensity of symptoms and paucity of external signs. These changes parallel those observed in somatic neuropathic pain. When seen through the neuroscience lens, diseases responsible for inadequately explained chronic eye pain (including those described as dry eye) can take on new meanings that may clarify long-standing enigmas and point to new approaches for developing preventive, symptomatic and disease-modifying interventions for these currently refractory disorders.
Topics: Cornea; Dry Eye Syndromes; Eye Pain; Humans; Neuralgia; Ophthalmic Nerve
PubMed: 25943558
DOI: 10.1136/bjophthalmol-2014-306280 -
Ophthalmic Plastic and Reconstructive...VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an adult-onset autoinflammatory disorder characterized by systemic inflammation (vasculitis,...
VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an adult-onset autoinflammatory disorder characterized by systemic inflammation (vasculitis, arthritis, chondritis, dermatosis) and hematologic abnormalities (thrombosis, cytopenia, vacuolization of marrow precursors). The patient demonstrated some of the adult-onset inflammatory and hematologic features, in addition to recurrent eye pain, chemosis and orbital inflammation. This case describes an instance of VEXAS syndrome in a patient with uncommon orbital symptoms such as scleritis and myositis.
Topics: Adult; Humans; Inflammation; Eye Pain; Myelodysplastic Syndromes; Myositis; Mutation
PubMed: 37405738
DOI: 10.1097/IOP.0000000000002450