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Ugeskrift For Laeger Jan 2023Sudden pain of the eye, nose or face can be a symptom of stroke located to the pons. This case report is about a 73-year-old women with acute debut of right-sided...
Sudden pain of the eye, nose or face can be a symptom of stroke located to the pons. This case report is about a 73-year-old women with acute debut of right-sided hemiparesis, ataxia, gait disturbance, dysarthria, hemisensory defects and contralateral burning eye pain. MRI showed acute ischaemia of the left pons. The case adds to the growing literature of this rare presentation of posterior circulation stroke.
Topics: Humans; Female; Aged; Eye Pain; Pons; Stroke; Brain Stem Infarctions; Magnetic Resonance Imaging
PubMed: 36760190
DOI: No ID Found -
Progress in Retinal and Eye Research Jul 2019The cornea is a valuable tissue for studying peripheral sensory nerve structure and regeneration due to its avascularity, transparency, and dense innervation.... (Review)
Review
The cornea is a valuable tissue for studying peripheral sensory nerve structure and regeneration due to its avascularity, transparency, and dense innervation. Somatosensory innervation of the cornea serves to identify changes in environmental stimuli at the ocular surface, thereby promoting barrier function to protect the eye against injury or infection. Due to regulatory demands to screen ocular safety of potential chemical exposure, a need remains to develop functional human tissue models to predict ocular damage and pain using in vitro-based systems to increase throughput and minimize animal use. In this review, we summarize the anatomical and functional roles of corneal innervation in propagation of sensory input, corneal neuropathies associated with pain, and the status of current in vivo and in vitro models. Emphasis is placed on tissue engineering approaches to study the human corneal pain response in vitro with integration of proper cell types, controlled microenvironment, and high-throughput readouts to predict pain induction. Further developments in this field will aid in defining molecular signatures to distinguish acute and chronic pain triggers based on the immune response and epithelial, stromal, and neuronal interactions that occur at the ocular surface that lead to functional outcomes in the brain depending on severity and persistence of the stimulus.
Topics: Animals; Cornea; Corneal Diseases; Eye Pain; Humans; Models, Theoretical; Neuralgia
PubMed: 30453079
DOI: 10.1016/j.preteyeres.2018.11.005 -
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 -
International Journal of Rheumatic... Apr 2024
Topics: Female; Humans; Eye Pain; Glucocorticoids; Treatment Outcome; Middle Aged
PubMed: 38661322
DOI: 10.1111/1756-185X.15148 -
MMW Fortschritte Der Medizin Feb 2023
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Tidsskrift For Den Norske Laegeforening... Sep 2019Typical optic neuritis is a demyelinating inflammation of the optic nerve, often associated with multiple sclerosis and with a relatively good prognosis. A small... (Review)
Review
Typical optic neuritis is a demyelinating inflammation of the optic nerve, often associated with multiple sclerosis and with a relatively good prognosis. A small percentage of optic neuritis cases have divergent clinical characteristics and a different underlying aetiology. These atypical cases of optic neuritis must be treated more intensively and followed up more closely in order to preserve visual function. It is important to be aware of the atypical features, so that correct assessment and treatment is initiated.
Topics: Adult; Aged; Chronic Disease; Eye Pain; Humans; Middle Aged; Neuromyelitis Optica; Optic Neuritis; Young Adult
PubMed: 31556528
DOI: 10.4045/tidsskr.18.0967 -
Expert Opinion on Therapeutic Targets Aug 2022Dysfunction at various levels of the somatosensory system can lead to ocular surface pain with a neuropathic component. Compared to nociceptive pain (due to noxious... (Review)
Review
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.
Topics: Humans; Dry Eye Syndromes; Neuralgia; Eye Pain
PubMed: 36069761
DOI: 10.1080/14728222.2022.2122438 -
Current Opinion in Ophthalmology Jul 2018To review current concepts regarding the mechanisms of postoperative pain after photorefractive keratectomy (PRK) and review available treatment options. (Review)
Review
PURPOSE OF REVIEW
To review current concepts regarding the mechanisms of postoperative pain after photorefractive keratectomy (PRK) and review available treatment options.
RECENT FINDINGS
Many clinical studies have established the safety and efficacy of different topical and systematic therapeutic agents and techniques for the treatment of postoperative pain after PRK, especially topical nonsteroidal anti inflammatory agents and oral nonsteroidal and narcotic medications. New therapeutic agents and techniques are continuously studied, introducing new agents and comparing teh efficacy of different regimens. Postoperative pain severity varies widely between patients, and no single strategy has been proven best for acute pain management.
SUMMARY
To date, the literature supports the use of topical agents such as nonsteroidal anti-inflammatory medications (NSAIDs) and diluted topical anesthetics in combination with oral agents such as opiates and NSAIDs for acute pain management. The use of local agents and techniques is preferred due to their less significant side effect profile. The use of systemic opiate agents is reserved for breakthrough pain.
Topics: Analgesics, Opioid; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Eye Pain; Humans; Myopia; Pain Management; Pain, Postoperative; Photorefractive Keratectomy
PubMed: 29708926
DOI: 10.1097/ICU.0000000000000486 -
Survey of Ophthalmology 2018Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the... (Review)
Review
Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the mechanisms, risk factors, and management of intraoperative and postoperative pain. Summaries of less common sources of physiologic pain have been included to reinforce recognition of when pain represents an expected physiologic reaction to surgery as opposed to signaling a more serious complication. We also discuss various current and emerging anesthetic and analgesic modalities.
Topics: Analgesia; Anesthesia; Cataract Extraction; Eye Pain; Humans; Pain Management; Pain Measurement; Pain, Postoperative; Perioperative Care; Perioperative Period; Risk Factors
PubMed: 28739400
DOI: 10.1016/j.survophthal.2017.07.002 -
Biologie Aujourd'hui 2018Dry eye disease (DED) is a common chronic condition with multifactorial etiologies that is increasing in prevalence worldwide, up to 20% in the elderly. The economic... (Review)
Review
Dry eye disease (DED) is a common chronic condition with multifactorial etiologies that is increasing in prevalence worldwide, up to 20% in the elderly. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable. Chronic ocular pain is the most common symptom of DED and there is currently no topical ocular analgesic therapy available to treat this debilitating disease. Eye pain can be perceived as itch, irritation, dryness, grittiness, burning, aching, and light sensitivity. Ocular pain is triggered by corneal nociceptors (cornea being the most sensory innervated tissue of the body). It was clearly established that repeated direct damage to ocular surface and per se corneal nerves can cause peripheral and central sensitization mechanisms explaining the ocular pain in some patients with DED. However, the brain regions and the neuronal pathways associated with ocular pain are still unclear. Thus, a better characterization of chronic ocular pain and an understanding of the peripheral and central molecular and cellular mechanisms involved are crucial issues for developing effective management and therapeutic strategy to alleviate ocular pain. In this review, we first describe the nociceptive corneal nerve pathways and the classification and the neurochemistry of primary afferents innervating the cornea. Then, an update of the fundamental and clinical studies related to the inflammatory processes linked to ocular pain is detailed. The last part of the review presents the diagnostic tools used in clinic for evaluating corneal sensitivity and corneal inflammation.
Topics: Chronic Pain; Comprehension; Cornea; Dry Eye Syndromes; Eye Pain; Humans; Retinal Neurons; Trigeminal Ganglion
PubMed: 30362450
DOI: 10.1051/jbio/2018017