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Emerging Infectious Diseases Apr 2016Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey...
Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey of the symptoms of all survivors from the Ebola treatment unit (ETU) at 34th Regimental Military Hospital, Freetown, Sierra Leone (MH34), was conducted after discharge at their initial follow-up appointment within 3 weeks after their second negative PCR result. From its opening on December 1, 2014, through March 31, 2015, the MH34 ETU treated 84 persons (8-70 years of age) with PCR-confirmed Ebola virus disease, of whom 44 survived. Survivors reported musculoskeletal pain (70%), headache (48%), and ocular problems (14%). Those who reported headache had had lower admission cycle threshold Ebola PCR than did those who did not (p<0.03). This complete survivor cohort from 1 ETU enables analysis of the proportion of symptoms of post-Ebola syndrome. The Ebola epidemic is waning, but the effects of the disease will remain.
Topics: Adolescent; Adult; Aged; Child; Cross-Sectional Studies; Disease Outbreaks; Ebolavirus; Eye Pain; Female; Headache; Hemorrhagic Fever, Ebola; Humans; Male; Middle Aged; Musculoskeletal Pain; Sierra Leone; Survivors; Syndrome
PubMed: 26983037
DOI: 10.3201/eid2204.151302 -
[Zhonghua Yan Ke Za Zhi] Chinese... Aug 2022The cornea is the most innervated tissue in the human body. Neuropathic pain occurring in the cornea has gradually attracted the attention of ophthalmologists. However,... (Review)
Review
The cornea is the most innervated tissue in the human body. Neuropathic pain occurring in the cornea has gradually attracted the attention of ophthalmologists. However, the definition and pathogenesis of neuropathic corneal pain (NCP) have not been clearly defined, making the diagnosis and treatment of the disease extremely challenging. In recent years, with the application of ocular surface pain assessment scales, confocal microscopy and functional magnetic resonance imaging in the clinical assessment of NCP, the diagnostic methods of NCP have been enriched. This paper reviewed the research progress of diagnostic methods of NCP, with a view to improving the ophthalmologists' understanding of NCP and promoting the application of these technologies in the diagnosis of NCP.
Topics: Cornea; Eye Pain; Humans; Microscopy, Confocal; Neuralgia
PubMed: 35959608
DOI: 10.3760/cma.j.cn112142-20211110-00531 -
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 -
Investigative Ophthalmology & Visual... Feb 2016To examine associations between corneal mechanical thresholds and metrics of dry eye.
PURPOSE
To examine associations between corneal mechanical thresholds and metrics of dry eye.
METHODS
This was a cross-sectional study of individuals seen in the Miami Veterans Affairs eye clinic. The evaluation consisted of questionnaires regarding dry eye symptoms and ocular pain, corneal mechanical detection and pain thresholds, and a comprehensive ocular surface examination. The main outcome measures were correlations between corneal thresholds and signs and symptoms of dry eye and ocular pain.
RESULTS
A total of 129 subjects participated in the study (mean age 64 ± 10 years). Mechanical detection and pain thresholds on the cornea correlated with age (Spearman's ρ = 0.26, 0.23, respectively; both P < 0.05), implying decreased corneal sensitivity with age. Dry eye symptom severity scores and Neuropathic Pain Symptom Inventory (modified for the eye) scores negatively correlated with corneal detection and pain thresholds (range, r = -0.13 to -0.27, P < 0.05 for values between -0.18 and -0.27), suggesting increased corneal sensitivity in those with more severe ocular complaints. Ocular signs, on the other hand, correlated poorly and nonsignificantly with mechanical detection and pain thresholds on the cornea. A multivariable linear regression model found that both posttraumatic stress disorder (PTSD) score (β = 0.21, SE = 0.03) and corneal pain threshold (β = -0.03, SE = 0.01) were significantly associated with self-reported evoked eye pain (pain to wind, light, temperature) and explained approximately 32% of measurement variability (R = 0.57).
CONCLUSIONS
Mechanical detection and pain thresholds measured on the cornea are correlated with dry eye symptoms and ocular pain. This suggests hypersensitivity within the corneal somatosensory pathways in patients with greater dry eye and ocular pain complaints.
Topics: Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; Cornea; Cross-Sectional Studies; Dry Eye Syndromes; Eye Pain; Female; Humans; Male; Middle Aged; Pain Threshold; Retrospective Studies; Surveys and Questionnaires; Tears
PubMed: 26886896
DOI: 10.1167/iovs.15-18133 -
Ophthalmic Plastic and Reconstructive... 2019Pain relief for a blind painful eye often follows an escalating paradigm of interventions. This study compares the efficacy of common interventions.
PURPOSE
Pain relief for a blind painful eye often follows an escalating paradigm of interventions. This study compares the efficacy of common interventions.
METHODS
A retrospective chart review of blind painful eye cases was conducted at a single tertiary institution from April 2012 to December 2016. Demographics, etiology, treatment, and pain level were assessed.
RESULTS
Among 99 blind painful eyes, 96 eyes initially received medical therapy (topical steroids, cycloplegics, and/or hypotensives), with pain relief in 39% of eyes. Minimally invasive interventions (laser cyclophotocoagulation, retrobulbar injection, or corneal electrocautery) were performed 41 times in 36 eyes, 34 of which had failed medical therapy, and led to pain relief in 75% of eyes. Evisceration or enucleation was performed in 28 eyes, and long-term pain relief was achieved in 100% of eyes. Surgery allowed discontinuation of oral analgesics in 100% of cases versus 20% for minimally invasive therapy (p = 0.005) and 14% for medical therapy (p = 0.0001). Compared with medical therapy, minimally invasive therapy was 2.5 times more likely to achieve lasting pain relief (p = 0.003) and surgical therapy 35.6 times more likely to achieve lasting pain relief (p = 0.011). High initial pain score was associated with nonsurgical treatment failure.
CONCLUSIONS
Medical therapy provides pain relief in a moderate number of patients with a blind painful eye. When medical therapy fails, minimally invasive therapy and surgical interventions are successively more effective in relieving ocular pain. High initial pain score is a risk factor for nonsurgical therapy failure and may merit an earlier discussion of surgical intervention.
Topics: Adult; Aged; Aged, 80 and over; Analgesics; Blindness; Eye Pain; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Pain Management; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 30134387
DOI: 10.1097/IOP.0000000000001205 -
The American Journal of Managed Care Jul 2019Topical ophthalmic corticosteroids are of clinical benefit in the management of pain and inflammation after ocular surgery; however, their use can be associated with...
Topical ophthalmic corticosteroids are of clinical benefit in the management of pain and inflammation after ocular surgery; however, their use can be associated with class-associated adverse events (AEs) and limited bioavailability. Selection of an appropriate topical corticosteroid depends on drug-specific variables such as AE profile, efficacy, potency, dosing, patient-specific administration needs, and formulation properties aimed at minimizing precorneal drug loss, increasing ocular surface drug residence time, and maximizing drug delivery to the anterior tissues. Recently, strategies for improving ocular penetration of ophthalmic formulations have included use of mucoadhesive formulations (ie, polycarbophil-containing gels) and drug particle size reduction, enabling faster drug dissolution and therefore increased bioavailability and penetration. Loteprednol etabonate (LE) is a carbon-20 ester corticosteroid developed through retrometabolic drug design with potent anti-inflammatory effects and a reduced propensity for eliciting corticosteroid class AEs. This drug has been formulated for topical ophthalmic use after surgery as 0.5% and 1% suspensions, a 0.5% ointment, and a 0.5% gel. Preclinical and clinical data for a new 0.38% LE gel will be reviewed demonstrating that reducing the drug particle size to the nanometer range in diameter provides effective ocular tissue penetration and resolution of pain and inflammation despite a reduced drug concentration (0.38%) and dosing frequency.
Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Allergic Agents; Eye Diseases; Eye Pain; Female; Humans; Inflammation; Loteprednol Etabonate; Male; Middle Aged; Ophthalmic Solutions; Postoperative Complications; United States
PubMed: 31419092
DOI: No ID Found -
Journal of Neurophysiology Mar 2023Despite extensive study, the mechanisms underlying pain after axonal injury remain incompletely understood. Pain after corneal refractive surgery provides a model, in...
Despite extensive study, the mechanisms underlying pain after axonal injury remain incompletely understood. Pain after corneal refractive surgery provides a model, in humans, of the effect of injury to trigeminal afferent nerves. Axons of trigeminal ganglion neurons that innervate the cornea are transected by laser-assisted in situ keratomileusis (LASIK). Although most patients do not experience postoperative pain, a small subgroup develop persistent ocular pain. We previously carried out genomic analysis and determined that some patients with persistent pain after axotomy of corneal axons during refractive surgery carry mutations in genes that encode the electrogenisome of trigeminal ganglion neurons, the ensemble of ion channels and receptors that regulate excitability within these cells, including , which encodes sodium channel Nav1.7, a threshold channel abundantly expressed in sensory neurons that has been implicated in a number of pain-related disorders. Here, we describe the biophysical and electrophysiological profiling of the P610T Nav1.7 mutation found in two male siblings with persistent ocular pain after refractive surgery. Our results indicate that this mutation impairs the slow inactivation of Nav1.7. As expected from this proexcitatory change in channel function, we also demonstrate that this mutation produces increased spontaneous activity in trigeminal ganglion neurons. These findings suggest that this gain-of-function mutation in Nav1.7 may contribute to pain after injury to the axons of trigeminal ganglion neurons. Mechanisms underlying pain after axonal injury remain elusive. A small subgroup of patients experience pain after corneal refractive surgery, providing a human pain model after well-defined injury to axons. Here we analyze a mutation (P610T) in Nav1.7, a threshold sodium channel expressed in nociceptors, found in two siblings with persistent ocular pain after refractive surgery. We show that it impairs channel slow inactivation, thereby triggering inappropriate repetitive activity in trigeminal ganglion axons that signal eye pain.
Topics: Humans; Male; Axons; Cornea; Eye Pain; Ganglia, Spinal; Mutation; NAV1.7 Voltage-Gated Sodium Channel; Neurons; Pain; Siblings
PubMed: 36722722
DOI: 10.1152/jn.00457.2022 -
The Ocular Surface Jul 2023Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x)...
PURPOSE
Sex hormones impact inflammatory and immune-mediated diseases. During IVF (in vitro fertilisation) treatment, circulating estrogen levels increase dramatically (10-50x) alongside changes in other hormones. This study examined changes in dry eye with IVF and its relationship with sex hormones.
METHODS
A two visit study was conducted on first day of menstruation when estrogen levels are lowest (baseline visit), and on day 9-11 (peak estrogen visit (PO)) of IVF. Symptoms of dry eye and ocular pain and signs of dry eye were examined. Serum hormone levels were assessed using mass spectrometry and immunoassay. Changes in signs and symptoms and associations were explored. Hierarchical multiple regression analysis assessed factors contributing to signs and symptoms.
RESULTS
40 women (36.2 ± 4.0 years) completed the study. Baseline and PO oestradiol (E2) levels were 28.9 pg/ml (20) (median (IQR)); 1360 pg/ml (1276) respectively. Ocular pain and dry eye symptoms worsened (p = 0.02 and p < 0.01) and tear break up and tear secretion values decreased (p = 0.005 and 0.01) at PO. Higher E2 and lower luteinizing hormone (LH) were associated with worsening of dry eye symptoms (ρ = 0.34 p = 0.03, ρ = -0.49 p = 0.001). Reduction in LH and increase in progesterone (P4) were associated with increased ocular pain (ρ = 0.45, p = 0.004 and ρ = 0.39, p = 0.01). Dry eye symptoms were predicted by LH and tear break up (p = 0.02; R = 0.18).
CONCLUSIONS
IVF treatment resulted in significantly increased ocular symptoms and tear film alterations although these changes were not clinically significant. Dry eye signs and symptoms were poorly predicted by hormone levels.
Topics: Humans; Female; Dry Eye Syndromes; Estrogens; Gonadal Steroid Hormones; Pain; Tears; Eye Pain; Fertilization in Vitro
PubMed: 37422153
DOI: 10.1016/j.jtos.2023.06.015 -
American Journal of Ophthalmology Feb 2023To examine neural mechanisms underlying photophobia in individuals with chronic ocular surface pain by using functional magnetic resonance imaging (fMRI).
PURPOSE
To examine neural mechanisms underlying photophobia in individuals with chronic ocular surface pain by using functional magnetic resonance imaging (fMRI).
DESIGN
Cross-sectional case/control analysis.
METHODS
A total of 16 individuals from the Miami Veterans Affairs eye clinic underwent comprehensive ocular surface evaluations and were surveyed for ocular surface symptoms. Case patients included patients who reported chronic ocular surface pain symptoms and light sensitivity at least most of the time over 1 week. Controls included persons without chronic ocular surface pain who reported no or minimal light sensitivity. All patients viewed light stimuli during 2 fMRI scans, one before and one after topical anesthetic instillation, and rated their level of pain intensity to the stimulus at the end of each scan. Areas of brain activation in response to light stimuli presentation were correlated with pain responses and examined post- vs pre-anesthesia.
RESULTS
Case patients (n = 8) reported higher pain intensity ratings than controls (n = 8) in response to light stimuli during fMRI. Case patient ratings correlated more with light-evoked activation in pain-related areas within the trigeminal brainstem, primary somatosensory cortex (S1), anterior mid-cingulate cortex (aMCC), and insula than in controls. Topical anesthesia led to varying responses in pain ratings among case patients as well as decreased light-evoked activation in S1 and aMCC.
CONCLUSIONS
The trigeminal nociceptive system may contribute to photophobia in individuals with chronic ocular surface pain. We demonstrate modulation of cortical structures in this pathway with topically applied anesthetic to the eyes. Further understanding of modulatory interactions that govern ocular surface pain and photophobia is critical for developing effective, precision-based therapies.
Topics: Humans; Photophobia; Cross-Sectional Studies; Eye Pain; Pain; Neuroimaging; Magnetic Resonance Imaging
PubMed: 36223850
DOI: 10.1016/j.ajo.2022.09.020 -
Journal of Cataract and Refractive... Feb 2021To evaluate the safety and efficacy of a nepafenac punctal plug delivery system (N-PPDS) after cataract surgery. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the safety and efficacy of a nepafenac punctal plug delivery system (N-PPDS) after cataract surgery.
SETTING
Three U.S. clinical sites.
DESIGN
Prospective, multicenter, randomized (2:1), parallel-arm, double-masked, placebo-controlled, phase II pilot study.
METHODS
Fifty-six subjects (aged older than 22 years) with expected postcataract correctable distance vision of 20/30 or better and lower puncta allowing dilation up to 1.0 mm received either the nepafenac (N-PPDS group; n = 38 eyes) or a placebo punctal plug delivery system (p-PPDS group; n = 18 eyes). All eyes underwent routine unilateral cataract surgery with intraocular lens implantation. The primary and secondary efficacy measures were postoperative ocular pain and inflammation, respectively.
RESULTS
There were 38 patients in the experimental N-PPDS group and 18 patients in the control group. The N-PPDS group had a significantly higher percentage of pain-free patients than that in the p-PPDS group (22/32 [69%] vs 6/16 [38%] at 3 days, P = .038; and 24/36 [67%] vs 5/16 [31%] at 7 days, P = .018). A higher percentage of patients in the N-PPDS group (15/29 [52%] vs 0/14 [0%] in p-PPDS) was pain free at all visits (P = .001). Anterior chamber cell scores were better in the N-PPDS group (patients with no anterior chamber cells: 18/36 [50%] vs 3/16 [19%] in p-PPDS; P = .034) at 7 days. The plug retention rate was 98% (55/56) at 14 days. Adverse events having a suspected relationship with the punctal plug treatment occurred in 1 case of the N-PPDS group having to do with placement and zero in the p-PPDS group.
CONCLUSIONS
The N-PPDS was safe and effective for the management of ocular pain and inflammation after cataract surgery.
Topics: Adult; Benzeneacetamides; Cataract; Double-Blind Method; Eye Pain; Humans; Inflammation; Phenylacetates; Pilot Projects; Postoperative Complications; Prospective Studies; Punctal Plugs; Treatment Outcome
PubMed: 32925651
DOI: 10.1097/j.jcrs.0000000000000414