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The British Journal of Ophthalmology Aug 2018To survey the frequency, character, severity and impact of ocular pain on quality of life in adult patients with non-infectious uveitis (NIU).
BACKGROUND/AIM
To survey the frequency, character, severity and impact of ocular pain on quality of life in adult patients with non-infectious uveitis (NIU).
METHODS
This patient-requested cross-sectional survey study describes the results of three self-administered questionnaires (the National Eye Institute Visual Function Questionnaire, the 36-Item Short Form Health Survey (SF-36) and the McGill Pain Questionnaire Dutch Language Version) from 147 patients with NIUs from a university-based tertiary referral centre in Utrecht.
RESULTS
The mean Visual Function Questionnaire (VFQ) Ocular Pain Score of all patients with NIU was 72 (±24), which is significantly lower than an ocular disease-free reference group (90±15, P<0.0001), indicating more ocular pain. This was true for all types of NIU, regardless of the localisation: although Ocular Pain Scores were lower in patients with anterior uveitis (AU) compared with patients with non-AU (mean 62 (±24) vs 74 (±24), P=0.04), patients with non-AU still scored substantially lower than the reference group that had no ocular history (P<0.0001). Patients with NIU also scored significantly lower on all other VFQ subscales as well as on the SF-36 subscales 'Role Limitations due to physical problems', 'Vitality', 'General health' and 'Bodily Pain' compared with controls. The VFQ Ocular Pain subscale correlated with other quality of life subscales (both VFQ-25 and SF-36), indicating a relationship between pain and quality of life.
CONCLUSION
This study shows that ocular pain is highly prevalent in patients with NIU, regardless of the localisation. Furthermore, ocular pain has an impact on quality of life.
Topics: Adult; Aged; Cross-Sectional Studies; Eye Pain; Female; Health Status; Humans; Male; Middle Aged; Netherlands; Prevalence; Quality of Life; Sickness Impact Profile; Surveys and Questionnaires; Uveitis; Visual Acuity
PubMed: 29378727
DOI: 10.1136/bjophthalmol-2017-311575 -
Transactions of the American... Aug 2017To evaluate associations between sensations of ocular itch and dry eye (DE) symptoms, including ocular pain, and DE signs.
PURPOSE
To evaluate associations between sensations of ocular itch and dry eye (DE) symptoms, including ocular pain, and DE signs.
METHODS
A cross-sectional study of 324 patients seen in the Miami Veterans Affairs eye clinic was performed. The evaluation consisted of questionnaires regarding ocular itch, DE symptoms, descriptors of neuropathic-like ocular pain (NOP), and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Analyses were performed to examine for differences between those with and without subjective complaints of ocular itch.
RESULTS
The mean age was 62 years with 92% being male. Symptoms of DE and NOP were more frequent in patients with moderate-severe ocular itch compared to those with no or mild ocular itch symptoms. With the exception of ocular surface inflammation (abnormal matrix metalloproteinase 9 testing) which was less common in those with moderate-severe ocular itch symptoms, DE signs were not related to ocular itch. Individuals with moderate-severe ocular itch also demonstrated greater sensitivity to evoked pain on the forearm and had higher non-ocular pain, depression, and post-traumatic stress disorders scores, compared to those with no or mild itch symptoms.
CONCLUSIONS
Subjects with moderate-severe ocular itch symptoms have more severe symptoms of DE, NOP, non-ocular pain and demonstrate abnormal somatosensory testing in the form of increased sensitivity to evoked pain at a site remote from the eye, consistent with generalized hypersensitivity.
Topics: Cornea; Cross-Sectional Studies; Dry Eye Syndromes; Eye Diseases; Eye Pain; Female; Humans; Male; Middle Aged; Ophthalmology; Pain Measurement; Pruritus; Quality of Life; Skin Physiological Phenomena; Societies, Medical; Surveys and Questionnaires; Tears; United States; Veterans
PubMed: 29391860
DOI: No ID Found -
European Journal of Ophthalmology Jul 2023The cause of ocular pain in the quiet eye is challenging to diagnose. It is a common complaint in the ophthalmology clinic and there are no actual guidelines on the...
BACKGROUND
The cause of ocular pain in the quiet eye is challenging to diagnose. It is a common complaint in the ophthalmology clinic and there are no actual guidelines on the exams that should be ordered initially. We decided to characterize patients with eye pain and normal ophthalmological examination who underwent ocular ultrasound, their findings, and systemic work-up.
METHODS
A retrospective chart review of patients who underwent ocular ultrasound due to ocular pain and no clinical findings on initial slit-lamp examination. We evaluated patient characteristics and analyzed systemic work-up results in contrast to ocular ultrasound findings.
RESULTS
Two hundred and three patients with normal slit-lamp examination and ocular pain were evaluated using ocular ultrasound at Clinica Barraquer. Most of the patients were women (88.7%), and 55% were older than 50 years. Nearly all of the patients had echographic findings, 87.7% of patients showed evidence of scleral scars, from which 66.5% had signs of activity, and 42.9% had thickened extraocular muscles. In general, most patients with ocular pain had normal results on systemic work-up, but the patients who did have positive results tended to have echographic findings.
CONCLUSION
Posterior inflammation is present in most patients with ocular pain in a quiet eye, and echography is an optimal tool to identify this. There is a tendency towards abnormal autoimmune test results and echographic findings. This should be considered in the initial work-up of these patients, given the importance of early diagnosis and the threat of vision loss with severe inflammation.
Topics: Humans; Female; Male; Eye Pain; Scleritis; Retrospective Studies; Vision Disorders; Inflammation; Ultrasonography
PubMed: 36539998
DOI: 10.1177/11206721221146670 -
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 -
The British Journal of Ophthalmology Sep 2020To evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.
PURPOSE
To evaluate the effect of one TrueTear session on change in tear volume and symptoms of dryness and ocular pain.
METHODS
Retrospective interventional case series of patients seen in a dry eye clinic. Seventy-five individuals underwent an ocular surface examination and one session of neurostimulation. Outcome measures included objective change in tear volume measured via phenol red test, and subjective change in sensations of dryness and ocular pain measured on a 0-10 Numerical Rating Scale.
RESULTS
The mean age of the 75 individuals was 59±13 years, and the majority were male (73%). Intranasal neurostimulation increased tear volume (mean 13.40±8.00 mm, p<0.0005) and reduced intensities of dryness (mean -2.85±2.79, p<0.0005) and ocular pain (mean -1.48±2.41, p<0.0005 for both). However, these effects were independent of one another as change in symptom report did not correlate with change in tear volume (r=-0.13, p=0.25 for dryness; r=0.07, p=0.56 for pain). In a multivariable model, the strongest predictors for increased tear volume were lower baseline tear volume (standardised beta (β)=-0.50, p<0.0005) and absence of an autoimmune disease (β=-0.36, p=0.001) (R=0.30). The strongest predictors for reduced dryness and pain scores were lower baseline dryness and ocular pain scores. No complications related to neurostimulation were noted.
CONCLUSION
Intranasal neurostimulation increased tear volume and reduced intensities of dryness and ocular pain, independently of one another.
Topics: Adult; Aged; Aged, 80 and over; Dry Eye Syndromes; Eye Pain; Female; Humans; Male; Middle Aged; Nasal Mucosa; Retrospective Studies; Tears; Transcutaneous Electric Nerve Stimulation
PubMed: 31831506
DOI: 10.1136/bjophthalmol-2019-315065 -
Scientific Reports Oct 2020Lacrimal gland excision (LGE) induced dry eye produces more severe corneal damage in female mice, yet signs of LGE-induced ocular pain and anxiety in male and female...
Lacrimal gland excision (LGE) induced dry eye produces more severe corneal damage in female mice, yet signs of LGE-induced ocular pain and anxiety in male and female mice have not been characterized. Excision of either the extraorbital gland (single LGE), or both the extraorbital and intraorbital glands (double LGE) was performed in male and female C57BL/6J mice to induce moderate and severe dry eye. Ongoing pain was assessed by quantifying palpebral opening and evoked nociceptive responses after corneal application of capsaicin and menthol. The open-field and plus maze were used to assess anxiety. Single LGE caused a reduction in palpebral opening and an increase in capsaicin and menthol-evoked responses only in female mice. Furthermore, single LGE produced signs of increased anxiety in female but not male mice. Overall, female mice appear more susceptible to signs of ocular pain, irritation, and anxiety in response to aqueous tear deficiency.
Topics: Animals; Anxiety; Capsaicin; Dry Eye Syndromes; Eye Pain; Female; Lacrimal Apparatus; Male; Menthol; Mice, Inbred C57BL; Pain Measurement; Sex Characteristics
PubMed: 33057056
DOI: 10.1038/s41598-020-73945-w -
Current Opinion in Ophthalmology May 2021The number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than five-fold from 1999 to 2016. Although surgeons only write 10% of... (Review)
Review
PURPOSE OF REVIEW
The number of opioid-related overdose deaths has rapidly increased since 2000, increasing more than five-fold from 1999 to 2016. Although surgeons only write 10% of opioid prescriptions annually, with ophthalmologists writing only a fraction of this amount, all physicians need to be cognizant of the current opioid epidemic and ways to decrease unnecessary opioid prescriptions.
RECENT FINDINGS
Previous work within ophthalmology has shown that retrobulbar anesthesia along with peri-operative intravenous or oral nonopioid analgesics can lead to decreased postoperative opioid use following ophthalmic surgery. Recent literature has shifted focus towards the use of opioid prescription guidelines in managing postoperative pain and decreasing the number of unnecessary opioids being prescribed by ophthalmologists. Overall, the frequency of opioid prescriptions may have gradually declined the past few years with such efforts, increased awareness, and new healthcare policies to monitor opioid prescriptions. However, ophthalmologists still continue to prescribe a substantial number of opioid medications, much of which may not be necessary.
SUMMARY
This review serves as a tool to aid all ophthalmologists in managing postoperative pain. There is a recent trend in addressing the opioid epidemic and efforts are being made to limit the overprescribing of opioids. Continued efforts are still required by all ophthalmologists to address the current opioid epidemic.
Topics: Analgesics, Opioid; Drug Prescriptions; Eye Pain; Humans; Ophthalmologic Surgical Procedures; Ophthalmology; Opioid-Related Disorders; Pain, Postoperative; Practice Patterns, Physicians'
PubMed: 33710008
DOI: 10.1097/ICU.0000000000000753 -
Eye & Contact Lens Nov 2018The purpose of this article is to provide a review of existing literature describing complications with contemporary contact lenses and their management. It is... (Review)
Review
The purpose of this article is to provide a review of existing literature describing complications with contemporary contact lenses and their management. It is envisioned that this will serve as a useful summary of noninfectious and infectious complications associated with contact lens wear.
Topics: Conjunctival Diseases; Contact Lenses; Contact Lenses, Hydrophilic; Corneal Diseases; Corneal Injuries; Dry Eye Syndromes; Eye Pain; Humans; Hypoxia
PubMed: 29373389
DOI: 10.1097/ICL.0000000000000481 -
Current Opinion in Ophthalmology Jul 2015Since the introduction of photoablative procedures, postoperative pain management has been a major challenge for both the patient and the surgeon. Over the years,... (Review)
Review
PURPOSE OF REVIEW
Since the introduction of photoablative procedures, postoperative pain management has been a major challenge for both the patient and the surgeon. Over the years, significant advances have been made in our ability to overcome this challenge. The purpose of this article is to discuss the most current strategies for pain control after photorefractive keratectomy and phototherapeutic keratectomy.
RECENT FINDINGS
Methods for pain control can be targeted locally or systemically and can be pharmacological or nonpharmalogical. Options include anesthetics, NSAIDs, opiates, and anticonvulsants, as well as bandage contact lenses and corneal cooling.
SUMMARY
Literature and experience provide insight on the efficacy and safety of the many options for post-photorefractive keratectomy pain control. Generally, refractive surgeons are using a combination approach to achieve pain control with excellent results.
Topics: Eye Pain; Humans; Pain Management; Pain, Postoperative; Photorefractive Keratectomy
PubMed: 26058021
DOI: 10.1097/ICU.0000000000000170 -
American Journal of Ophthalmology May 2022To examine dry eye (DE) symptoms and signs in individuals with vs without Gulf War illness (GWI).
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.
Topics: Cross-Sectional Studies; Dry Eye Syndromes; Eye Pain; Gulf War; Humans; Persian Gulf Syndrome; Prospective Studies; Veterans
PubMed: 34780800
DOI: 10.1016/j.ajo.2021.11.010