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Investigative Ophthalmology & Visual... May 2023Patients with dry eye disease (DED) sometimes complain of ocular pain. DED-related ocular pain has many similarities with neuropathic pain. Mirogabalin, a novel ligand...
PURPOSE
Patients with dry eye disease (DED) sometimes complain of ocular pain. DED-related ocular pain has many similarities with neuropathic pain. Mirogabalin, a novel ligand for the α2δ subunit of voltage-gated calcium channels, is approved for treating neuropathic pain in Japan. This study aimed to investigate the effect of mirogabalin on hyperalgesia and chronic ocular pain in a rat DED model.
METHODS
DED was induced in female Sprague Dawley rats by unilaterally excising the external lacrimal gland (ELG) and Harderian gland (HG). After 4 weeks of ELG and HG removal, tear production (pH threads) and corneal epithelial damage (fluorescein staining) were evaluated. Corneal hyperalgesia and chronic pain were analyzed, respectively, by measuring capsaicin-induced eye-wiping behavior and c-Fos expression in the trigeminal nucleus. Mirogabalin (10 or 3 mg/kg) was evaluated for effects on DED-induced hyperalgesia and chronic ocular pain.
RESULTS
Tear production was significantly lower in DED-induced eyes than in control eyes. Corneal damage was significantly higher in DED eyes than in control eyes. Hyperalgesia and chronic ocular pain were detected 4 weeks after ELG and HG removal. Five days of mirogabalin administration significantly suppressed capsaicin-induced eye-wiping behavior, which indicated the suppression of ocular hyperalgesia. Administration of 10 mg/kg mirogabalin significantly reduced c-Fos expression in the trigeminal nucleus, which indicated the amelioration of chronic ocular pain.
CONCLUSIONS
Mirogabalin suppressed DED-induced hyperalgesia and chronic ocular pain in a rat DED model. Our findings suggested that mirogabalin might effectively alleviate chronic ocular pain in patients with DED.
Topics: Rats; Female; Animals; Chronic Pain; Hyperalgesia; Rats, Sprague-Dawley; Capsaicin; Tears; Dry Eye Syndromes; Eye Pain; Neuralgia
PubMed: 37233999
DOI: 10.1167/iovs.64.5.27 -
The Ocular Surface Oct 2022Neurotrophic keratopathy (NK) is a degenerative disorder of the cornea characterized by decreased sensory innervation, epitheliopathy, and impaired epithelial healing....
PURPOSE
Neurotrophic keratopathy (NK) is a degenerative disorder of the cornea characterized by decreased sensory innervation, epitheliopathy, and impaired epithelial healing. In this study, we assessed ocular pain and quality-of-life-related parameters in ocular graft-versus-host disease (oGVHD) patients with and without NK.
METHODS
We included 213 oGVHD patients in this retrospective study, including 29 patients with NK assessed by the Cochet-Bonnet esthesiometer. We evaluated their records for ocular pain assessment survey (OPAS) scores and clinical parameters, including corneal sensation, corneal fluorescein staining (CFS) score, Schirmer's test, tear break-up time (TBUT), and ocular surface disease index (OSDI) score.
RESULTS
oGVHD patients with NK had lower corneal sensation (3.4 ± 1.4 vs. 5.9 ± 0.3; p < 0.0001), higher CFS scores (6.4 ± 4.2 vs. 4.7 ± 4.0; p = 0.01), and lower TBUT scores (1.2 ± 2.1 vs. 2.2 ± 3.1; p = 0.08) compared to oGVHD patients without NK and additionally had significantly higher ocular pain intensity scores (OPAS 24-h average eye pain intensity: 2.0 ± 2.8 vs. 1.1 ± 1.9; p = 0.03). Patients with NK more commonly reported burning (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.021) and sensitivity to light (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.049) as compared to patients without NK.
CONCLUSION
Clinical signs of ocular surface disease are worse in oGVHD patients with NK compared to oGVHD patients without NK. These patients additionally experience higher intensity ocular pain and lower quality-of-life-related parameters.
Topics: Humans; Graft vs Host Disease; Dry Eye Syndromes; Retrospective Studies; Tears; Eye Pain; Fluorescein; Keratitis; Corneal Dystrophies, Hereditary; Trigeminal Nerve Diseases
PubMed: 35948166
DOI: 10.1016/j.jtos.2022.07.005 -
Pediatrics in Review Oct 2016Primary care physicians are often the first to see a child with the complaint of eye pain. The eye examination in children is not easy, and the entities that can cause... (Review)
Review
Primary care physicians are often the first to see a child with the complaint of eye pain. The eye examination in children is not easy, and the entities that can cause pain in children range from a foreign body in the cornea to the most serious amblyogenic (inducing decreased vision) and life-threatening conditions. Eye pain is a red flag for ocular and systemic conditions, either in a "quiet eye" or "red eye." A detailed history of present illness; pertinent review of systems; close attention to the past medical, family, and social histories; and meticulous physical examination can help to determine the cause, establish the correct treatment, and serve as the basis for referral to a pediatric ophthalmologist if necessary.
Topics: Child; Diagnosis, Differential; Eye Diseases; Eye Pain; Humans; Physical Examination; Referral and Consultation
PubMed: 27694119
DOI: 10.1542/pir.2015-0096 -
Current Opinion in Allergy and Clinical... Oct 2017This review aims to describe the recent findings on epidemiology, pathophysiology, and management of neuropathic symptoms of the ocular surface, with a focus on... (Review)
Review
PURPOSE OF REVIEW
This review aims to describe the recent findings on epidemiology, pathophysiology, and management of neuropathic symptoms of the ocular surface, with a focus on potential similarities between sensations of dry eye, pain and itch.
RECENT FINDINGS
A narrative review of the literature was undertaken. Key references from research in dry eye, neuropathic symptoms of the ocular surface, ocular pain and itch, as well as general references on itch and pain neurobiology were included. Recent findings suggest aspects of dry eye, chronic ocular pain and itch symptomatology are driven by neuropathic pain mechanisms involving peripheral and central sensitization processes.
SUMMARY
Ocular dryness, pain, and itch are prevalent complaints with several of shared features. Multiple lines of evidence suggest that peripheral and central neuronal sensitization processes are involved in generating and maintaining ocular sensory symptoms. Research is warranted on the epidemiology of ocular sensations, molecular mechanisms involved in nociception and pruriception in the eye, electrophysiological alterations in animal models of eye conditions, and therapeutic modalities that can alleviate unpleasant ocular sensations.
Topics: Animals; Central Nervous System; Disease Models, Animal; Dry Eye Syndromes; Eye; Eye Pain; Humans; Neuralgia; Ocular Physiological Phenomena; Peripheral Nervous System; Pruritus; Sensation
PubMed: 28858914
DOI: 10.1097/ACI.0000000000000389 -
Current Opinion in Ophthalmology Sep 2014The aim of this review is to summarize causes of pain and discomfort in the anophthalmic socket and to aid the clinician in evaluating anophthalmic patients. (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to summarize causes of pain and discomfort in the anophthalmic socket and to aid the clinician in evaluating anophthalmic patients.
RECENT FINDINGS
Causes of pain and discomfort can be categorized into dysfunctional orbit/anophthalmic socket, phantom eye pain, and psychological/psychiatric factors. Recent research has brought attention to the role of prosthesis deposits in mucous formation, meibomian gland dysfunction causing dry socket, and the anophthalmic patients' experience of phantom eye pain.
SUMMARY
Anophthalmic patients may experience pain and discomfort for a variety of reasons. The treating physician needs to recognize this as treatment options are distinctly different.
Topics: Eye Enucleation; Eye Evisceration; Eye Pain; Humans; Orbit; Orbital Diseases; Orbital Implants; Postoperative Complications
PubMed: 24878963
DOI: 10.1097/ICU.0000000000000069 -
JAMA Ophthalmology Mar 2018
Topics: Eye Foreign Bodies; Eye Injuries, Penetrating; Eye Pain; Humans; Lacrimal Apparatus; Male; Metals; Middle Aged; Ophthalmologic Surgical Procedures; Orbit; Tomography, X-Ray Computed; Visual Acuity; Wounds, Gunshot
PubMed: 29192308
DOI: 10.1001/jamaophthalmol.2017.4050 -
The Ocular Surface Oct 2022Chronic 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... (Review)
Review
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.
Topics: Humans; Quality of Life; Dry Eye Syndromes; Eye Pain; Eye; Neuralgia
PubMed: 35970433
DOI: 10.1016/j.jtos.2022.08.005 -
Indian Journal of Ophthalmology Jun 2023Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of... (Review)
Review
Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.
Topics: Humans; Palliative Care; Eye Enucleation; Eye Evisceration; Quality of Life; Eye Pain
PubMed: 37322649
DOI: 10.4103/IJO.IJO_3063_22 -
Journal of Neuro-ophthalmology : the... Mar 2022Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating... (Review)
Review
BACKGROUND
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating pandemic. Although its respiratory effects can be deadly and debilitating, it can lead to other systemic disorders, such as those causing eye pain and headache. This literature review aims to describe presentations of eye pain and headache in relation to COVID-19, with an emphasis on how these disorders help us to understand the pathophysiology of COVID-19.
EVIDENCE ACQUISITION
Literature was mined from the PubMed database using the key terms: "eye pain," "conjunctivitis," "episcleritis," "optic neuritis," "migraine," and "headache" in conjunction with "COVID-19" and "SARS-CoV-2." With the exception of general background pathology, articles that predated 2006 were excluded. Case reports, literature reviews, and meta-analyses were all included. Where SARS-CoV-2 research was deficient, pathology of other known viruses was considered. Reports of ocular manifestations of vision loss in the absence of eye pain were excluded. The primary search was conducted in June 2021.
RESULTS
The literature search led to a focused review of COVID-19 associated with conjunctivitis, episcleritis, scleritis, optic neuritis, and myelin oligodendrocyte glycoprotein-associated optic neuritis. Four distinct COVID-19-related headache phenotypes were identified and discussed.
CONCLUSIONS
Eye pain in the setting of COVID-19 presents as conjunctivitis, episcleritis, scleritis, or optic neuritis. These presentations add to a more complete picture of SARS-CoV-2 viral transmission and mechanism of host infection. Furthermore, eye pain during COVID-19 may provide evidence of hypersensitivity-type reactions, neurovirulence, and incitement of either novel or subclinical autoimmune processes. In addition, investigation of headaches associated with COVID-19 demonstrated 4 distinct phenotypes that follow third edition of the International Classification of Headache Disorders categories: headaches associated with personal protective equipment, migraine, tension-type headaches, and COVID-19-specific headache. Early identification of headache class could assist in predicting the clinical course of disease. Finally, investigation into the COVID-19-associated headache phenotype of those with a history of migraine may have broader implications, adding to a more general understanding of migraine pathology.
Topics: COVID-19; Conjunctivitis; Eye Pain; Headache; Humans; Migraine Disorders; Optic Neuritis; SARS-CoV-2; Scleritis
PubMed: 35051986
DOI: 10.1097/WNO.0000000000001526 -
Current Opinion in Ophthalmology Nov 2020Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians,... (Review)
Review
PURPOSE OF REVIEW
Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination.
RECENT FINDINGS
This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis.
SUMMARY
Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.
Topics: Chronic Disease; Dry Eye Syndromes; Eye Pain; Headache; Humans; Recurrence
PubMed: 33009080
DOI: 10.1097/ICU.0000000000000702