-
Cornea May 2021A consecutive case series of patients with dupilumab-associated ocular surface disease (DAOSD) that describes common ocular symptoms and signs, proposes a symptom...
PURPOSE
A consecutive case series of patients with dupilumab-associated ocular surface disease (DAOSD) that describes common ocular symptoms and signs, proposes a symptom disease severity grading system, and describes treatment strategies of DAOSD patients was evaluated.
METHODS
A retrospective chart review of patients with concomitant dupilumab-treated atopic dermatitis and DAOSD with ophthalmic evaluation between January 2014 and May 2019 was conducted.
RESULTS
Twenty-nine patients (mean age 46 years, M/F: 12/17) with 57 ophthalmic exams were identified. The most common ocular symptoms included irritation/pain (n = 28, 97%), redness (n = 24, 83%), pruritus (n = 18, 62%), discharge (n = 18, 62%), and light sensitivity (n = 6, 21%). The most frequent signs included conjunctival injection (n = 18, 62%), superficial punctate keratitis (n = 16, 55%), and papillary reaction (n = 8, 28%). Topical corticosteroids (TCS) (n = 23, 79%), tacrolimus (n = 6, 21%), and artificial tears (n = 7, 24%) were the most commonly used therapies. Of those with follow-up documentation (n = 21), 20 were noted to have partial or complete response with TCS based on symptoms and reduction of signs. Using our proposed symptom-based grading scale, scaled 1 to 5 based on the presence of common symptoms listed above, 66% (n = 19) requiring topical immunomodulating therapy were found in the 'severe' group (≥3 symptoms) and 17% (n = 5) were found in the 'mild' group (≤2 symptoms).
CONCLUSIONS
This study provides insight into the commonly presenting ocular signs and symptoms associated with DAOSD and highlights the efficacy of TCS and other immunomodulators in improving symptoms associated with DAOSD. Based on our findings, we propose a symptom-based grading system that can guide nonophthalmic physicians regarding ophthalmology consult.
Topics: Adolescent; Adult; Aged; Anti-Allergic Agents; Antibodies, Monoclonal, Humanized; Child; Conjunctivitis; Dermatitis, Atopic; Eye Pain; Female; Follow-Up Studies; Glucocorticoids; Humans; Keratitis; Male; Middle Aged; Retrospective Studies; Severity of Illness Index; Tacrolimus; Treatment Outcome
PubMed: 32826648
DOI: 10.1097/ICO.0000000000002461 -
Neuromodulation : Journal of the... Dec 2018"Dry eye" or "keratoconjunctivitis sicca" is a multifactorial disease estimated to have a worldwide prevalence of 5-33%. Conventional therapies targeting the ocular...
INTRODUCTION
"Dry eye" or "keratoconjunctivitis sicca" is a multifactorial disease estimated to have a worldwide prevalence of 5-33%. Conventional therapies targeting the ocular surface with artificial tears, anti-inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic-like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals.
METHODS
All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic-like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre-treatment and five min post-treatment via a two-tailed paired Student's t-test.
RESULTS
The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p < 0.05, paired t-test). The use of TENS significantly decreased light sensitivity in both eyes (p < 0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p < 0.05, paired t-test).
DISCUSSION
Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal-thalamic-cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.
Topics: Adult; Aged; Chronic Pain; Eye Pain; Female; Humans; Keratoconjunctivitis Sicca; Male; Middle Aged; Pain; Pain Management; Photophobia; Retrospective Studies; Transcutaneous Electric Nerve Stimulation
PubMed: 29283468
DOI: 10.1111/ner.12742 -
Survey of Ophthalmology 2015Pain in ophthalmic surgery is a neglected area. We systematically reviewed the factors associated with postoperative pain and analgesic consumption in ophthalmic surgery... (Review)
Review
Pain in ophthalmic surgery is a neglected area. We systematically reviewed the factors associated with postoperative pain and analgesic consumption in ophthalmic surgery and found 12 studies with 1,515 participants. The median number of patients in the included studies was 59. Female sex, longer duration of surgical procedure, second eye surgery as a consecutive procedure, type of surgery, general anesthesia, lower satisfaction with anesthesia, and postoperative nausea may contribute to increased postoperative pain intensity. Type of surgery, type of anesthesia, and patient satisfaction with anesthesia were associated with increased analgesic consumption. The studies reviewed were heterogeneous in terms of surgical procedures, patient populations, tools for pain assessment, and timing of postoperative pain measurement. Multiple factors may be associated with increased postoperative pain and analgesic consumption and warrant further research.
Topics: Analgesics; Eye Pain; Female; Humans; Male; Ophthalmologic Surgical Procedures; Pain Measurement; Pain, Postoperative; Risk Factors
PubMed: 25890623
DOI: 10.1016/j.survophthal.2014.10.003 -
Molecular Pain 2017Recent data suggest that corneal somatosensory dysfunction may be the underlying cause of severe dry eye symptoms in the absence of ocular surface pathology seen in a... (Review)
Review
Recent data suggest that corneal somatosensory dysfunction may be the underlying cause of severe dry eye symptoms in the absence of ocular surface pathology seen in a subset of patients diagnosed with “dry eye syndrome.” This subset of patients tends to demonstrate a unique constellation of symptoms that are persistent, more severe, and generally respond poorly to current dry eye therapies targeting inadequate or dysfunctional tears. A growing body of literature suggests that symptoms in these patients may be better characterized as neuropathic ocular pain rather than dry eye. In these patients, dry eye symptoms are often associated with numerous comorbid pain conditions and evidence of central pain processing abnormalities, where eye pain is just one of multiple overlapping peripheral manifestations. In this review, we discuss the concept and potential mechanisms of chronic overlapping pain conditions as well as evidence for considering neuropathic ocular pain as one of these overlapping pain conditions.
Topics: Animals; Chronic Disease; Chronic Pain; Cornea; Dry Eye Syndromes; Eye Pain; Humans; Neuralgia; Pain Measurement
PubMed: 28814146
DOI: 10.1177/1744806917729306 -
Current Eye Research Jul 2021: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.: Patients scheduled for cataract surgery...
: To investigate whether timing influences pain perception during cataract surgery and to investigate the possible mechanisms.: Patients scheduled for cataract surgery both in the morning and afternoon were consecutively enrolled. Questionnaires to evaluate anxiety, including the Simplified State-Trait Anxiety Inventory, Amsterdam Preoperative Anxiety and Information Scale, and a visual analogue scale (VAS) for anxiety, were completed preoperatively, whereas a VAS for pain and the Wong-Baker FACES® Pain Rating Scale questionnaire were completed after surgery. Preoperative blood pressure and heart rate were recorded. Blood samples were acquired before surgery, and plasma cortisol, adrenocorticotropic hormone, adrenalin, and noradrenalin were tested.: Fifty-five patients underwent uneverntful cataract surgery (28 in the morning and 27 in the afternoon) were included in the final analysis. Greater intraoperative pain perception during cataract surgery was reported in the afternoon than in the morning. Overall anxiety levels were significantly higher in the afternoon. Plasma adrenalin levels were significantly higher in the afternoon. Cortisol levels were higher in the afternoon. Preoperative anxiety levels were closely related to intraoperative pain perception. Both adrenalin and cortisol correlated positively with preoperative anxiety, but only adrenalin correlated significantly with the pain scores.: Patients undergoing cataract surgery in the afternoon showed more preoperative anxiety, which may have increased their relevant stress hormones. Both the patient's emotional state and hormone levels may together aggravate his/her perceived pain in the afternoon. Monitoring preoperative anxiety levels, blood pressure, and heart rate should help to identify patients at higher risk of perceived intraoperative pain.:Trial registration number: NCT02182921Registration site: clinicaltrials.gov.
Topics: Aged; Anxiety Disorders; Blood Pressure; Epinephrine; Eye Pain; Female; Heart Rate; Humans; Hydrocortisone; Intraoperative Period; Lens Implantation, Intraocular; Male; Middle Aged; Pain Measurement; Pain Perception; Phacoemulsification; Surveys and Questionnaires; Time Factors
PubMed: 33249933
DOI: 10.1080/02713683.2020.1857776 -
Ophthalmic Epidemiology Aug 2023To identify periodic trends in internet searches for ocular symptoms and to determine the seasonal peaks and troughs.
PURPOSE
To identify periodic trends in internet searches for ocular symptoms and to determine the seasonal peaks and troughs.
METHODS
This cross-sectional study examined publicly available Google Trends data from the United States (01/01/2015 to 12/31/2019). A list of common ocular symptoms was compiled from the American Academy of Ophthalmology Eye Health website and Wills Eye Manual. Ocular symptoms were stratified into categories involving vision change, eye pain, or eye redness. The search volume over time for each term was modeled using periodic regression functions and the goodness-of-fit was reported. Fisher's exact tests were used to compare the characteristics of periodic vs. non-periodic query terms.
RESULTS
Seasonal trends were demonstrated by 45% (48/106) of the ocular symptoms included in this investigation. Search terms with best fit to the periodic model included stye (r = 0.89), pink eye (r = 0.82), dry eye (r = 0.76), blurry vision (r = 0.72), and swollen eye (r = 0.71). Periodic search terms were more likely to involve eye redness (21% vs. 11%, p = .014) and less likely to involve vision change (11% vs. 36%; p < .001). Periodic queries involving eye redness most often peaked in the spring and those involving eye pain peaked in the summer.
CONCLUSION
Ocular symptom queries directly reflect seasonal trends for allergic eye disease and ocular trauma. Search query analyses can serve as accurate epidemiological tools with research and real-world clinical applications.
Topics: Humans; United States; Eye Pain; Cross-Sectional Studies; Eye Diseases; Ophthalmology; Internet
PubMed: 36103713
DOI: 10.1080/09286586.2022.2119260 -
BMC Ophthalmology Jan 2024The management of post-refractive surgery dry eye disease (DED) can be challenging in clinical practice, and patients usually show an incomplete response to traditional...
BACKGROUND
The management of post-refractive surgery dry eye disease (DED) can be challenging in clinical practice, and patients usually show an incomplete response to traditional artificial tears, especially when it is complicated with ocular pain. Therefore, we aim to investigate the efficacy of combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate treatment in post-refractive surgery DED patients with ocular pain unresponsive to traditional artificial tears.
METHODS
We enrolled 30 patients with post-refractive surgery DED with ocular pain who were unresponsive to traditional artificial tears. Topical 0.05% cyclosporine A and 0.1% sodium hyaluronate were used for 3 months. They were evaluated at baseline and 1 and 3 months for dry eye and ocular pain symptoms and objective parameters, including Numerical Rating Scale (NRS), Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-Eye), tear break-up time (TBUT), Schirmer I test (SIt), corneal fluorescein staining (CFS), corneal sensitivity, and corneal nerve morphology. In addition, tear levels of inflammatory cytokines and neuropeptides were measured using the Luminex assay.
RESULTS
After 3 months of treatment, patients showed a statistically significant improvement in the ocular surface disease index (OSDI), TBUT, SIt, CFS, and corneal sensitivity (all P < 0.01) using linear mixed models. As for ocular pain parameters, the NRS and NPSI-Eye scores were significantly reduced (both P < 0.05) and positively correlated with the OSDI and CFS scores. Additionally, tear IL-1β, IL-6, and TNF-α levels were improved better than pre-treatment (P = 0.01, 0.03, 0.02, respectively).
CONCLUSION
In patients with post-refractive surgery DED with ocular pain, combined topical 0.05% cyclosporine A and 0.1% sodium hyaluronate treatment improved tear film stability, dry eye discomfort, and ocular pain, effectively controlling ocular inflammation.
TRIAL REGISTRATION
Registration number: NCT06043908.
Topics: Humans; Hyaluronic Acid; Cyclosporine; Lubricant Eye Drops; Eye Pain; Refractive Surgical Procedures; Pain; Lacerations; Cornea
PubMed: 38247010
DOI: 10.1186/s12886-024-03294-z -
The Ocular Surface Oct 2020Neuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with...
PURPOSE
Neuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with a centralized component of pain. This study aims to assess the efficacy and tolerability of the tricyclic antidepressant, nortriptyline, among NCP patients.
METHODS
Patients with clinically diagnosed NCP and a centralized component of pain, treated with oral nortriptyline, who had recorded pain scores as assessed by the ocular pain assessment survey at the first and last visit were included. Patients were excluded if they had any other ocular pathology that might result in pain or had less than 4 weeks of nortriptyline use. Demographics, time between visits, concomitant medications, systemic and ocular co-morbidities, duration of NCP, side effects, ocular pain scores, and quality of life (QoL) assessment were recorded.
RESULTS
Thirty patients with a mean age of 53.1 ± 18.5 were included. Male to female ratio was 8:22. Mean ocular pain in the past 24 h improved from 5.7 ± 2.1 to 3.6 ± 2.1 after 10.5 ± 9.1 months (p < 0.0001). Twelve patients (40.0%) had equal to or more than 50% improvement, 6 patients (20.0%) had 30-49% improvement, 6 patients (20.0%) had 1-29% improvement, 4 patients (13.3%) did not improve, while 2 patients (6.7%) reported increase in pain levels. Mean QoL improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p = 0.019). Eight patients (26.6%) discontinued treatment due to persistent side effects, despite improvement by 22.4%.
CONCLUSION
Nortriptyline was effective in relieving NCP symptoms in patients with centralized component and insufficient response to other systemic and topical therapies who tolerated the drug for at least 4 weeks. Nortriptyline may be used in the management of patients with NCP.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic; Eye Pain; Female; Humans; Male; Middle Aged; Neuralgia; Nortriptyline; Quality of Life; Young Adult
PubMed: 32860971
DOI: 10.1016/j.jtos.2020.08.006 -
Pain Medicine (Malden, Mass.) Dec 2018The aim of this study was to examine visual function and eye symptoms in fibromyalgia patients, with a particular focus on dry eye syndrome and eye pain.
OBJECTIVES
The aim of this study was to examine visual function and eye symptoms in fibromyalgia patients, with a particular focus on dry eye syndrome and eye pain.
METHODS
A tertiary care center-based cross-sectional study was carried out in chronic musculoskeletal pain patients diagnosed with fibromyalgia. Chronic musculoskeletal pain patients without fibromyalgia were enrolled as a comparison group. Self-reported eye pain was investigated with the McGill pain questionnaire and the numeric rating scale. In addition, we assessed corrected visual acuity, vision-related quality of life, and self-reported dry eye syndrome.
RESULTS
A total of 90 musculoskeletal pain patients were included, with 66 patients fulfilling American College of Rheumatology 1990 criteria for fibromyalgia. Sixty-seven percent (95% confidence interval [CI] = 56%-78%) of the fibromyalgia patients reported eye pain, and 62% (95% CI = 43%-81%) of those were without fibromyalgia diagnosis. Sixty-seven percent (95% CI = 56%-78%) of the fibromyalgia patients reported an experience of dry eye compared with 76% (95% CI = 57%-95%) in the nonfibromyalgia group. Vision-related quality of life was noticeably reduced in both groups.
CONCLUSIONS
Eye pain and dry eye are common in chronic pain patients, with comparable prevalence in musculoskeletal pain patients with and without fibromyalgia.
Topics: Adult; Chronic Pain; Cross-Sectional Studies; Dry Eye Syndromes; Eye Pain; Female; Fibromyalgia; Humans; Male; Middle Aged; Prevalence; Quality of Life
PubMed: 29554368
DOI: 10.1093/pm/pny045 -
Biomedicine & Pharmacotherapy =... Feb 2022Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment.
BACKGROUND
Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment.
METHODS
Literature search includes the most relevant repositories for medical scientific literature from inception until November, 24 2021. Data collection and selection of retrieved records adhere to PRISMA criteria.
RESULTS
In agreement with a priori established protocol the search retrieved 2471 records leaving 479 results after duplicates removal. Eleven records result from title and abstract screening to meet the inclusion criteria; only 4 results are eligible for inclusion in the qualitative synthesis impeding meta-analysis. The qualitative analysis highlights the antinociceptive and anti-inflammatory efficacy of Δ8-tetrahydrocannabinol, cannabidiol and its derivative HU-308 and of new racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229. Moreover, CB2R agonists RO6871304 and RO6871085 and CB2R ligand HU910 provide evidence of anti-inflammatory efficacy. CB2 agonist HU308 reduces of 241% uveitis-induced leukocyte adhesion and changes lipidome profile. Methodological and design issues raise concern of risk of bias and the amount of studies is too small for generalization. Furthermore, the ocular pain model used can resemble only inflammatory but not neuropathic pain.
CONCLUSIONS
The role of the endocannabinoid system in ocular pain is underinvestigated, since only two studies assessing the effects of cannabinoid receptors modulators on pain behavior and other two on pain-related inflammatory processes are found. Preclinical studies investigating the efficacy of cannabinoids in ocular inflammatory and neuropathic pain models are needed to pave the way for clinical translation.
Topics: Animals; Anti-Inflammatory Agents; Cannabidiol; Cannabinoid Receptor Agonists; Cannabinoids; Disease Models, Animal; Dronabinol; Drug Evaluation, Preclinical; Eye Pain; Leukocytes; Lipid Metabolism; Rodentia; Uveitis
PubMed: 34891121
DOI: 10.1016/j.biopha.2021.112505