Characteristics of Ocular Pain Complaints in Patients With Idiopathic Dry Eye Symptoms

Abstract

Objective The purpose of this study was to examine the severity and quality of ocular pain complaints in patients with dry eye symptoms. Methods Subjects with clinically-relevant dry eye symptoms (dryness, discomfort, tearing) of unknown origin seen in the Miami Veterans Affairs eye clinic were administered questionnaires for dry eye symptoms and ocular pain and underwent a standardized ocular examination. Qualities and severity ratings of ocular pain in subjects with idiopathic dry eye were compared to similar measures from published data in other chronic pain populations. Results The study sample consisted of 154 subjects, of which 91% were male and ranged in age from 27 to 89 (mean age = 61). Fifty-three percent of participants reported an average ocular pain of at least moderate intensity (numerical rating scale (NRS) ≥ 4), with specific characteristics (i.e., “burning” spontaneous pain) reported at frequencies comparable to prevalent chronic neuropathic pain syndromes as reported in the literature. Significant correlations were found between ocular pain metrics and dry eye symptom severity scores (r=0.57 to 0.66). Dry eye signs, however, did not generally correlate with ocular pain severity. Conclusions A significant proportion of subjects with idiopathic dry eye symptoms reported moderate or greater ocular pain intensity, with the majority endorsing descriptors commonly used by patients with non-ocular neuropathic pain conditions. Identifying sub-groups of dry eye patients based on the presence and characteristics of ocular pain complaints may improve dry eye sub classification and better individualize treatment strategies.

Bulbar conjunctival microvascular responses in dry eye

“…20 For the evoked pain subsection of the NPSI, we replaced the three original questions regarding the severity of allodynia or hyperalgesia caused by 1) light touch, 2) pressure, or 3) contact with something cold on the skin, with questions specific to ocular allodynia or hyperalgesia [eye pain caused or increased by 1) wind, 2) light, and 3) heat or cold. Our strategy was to use both standardized assessments of dry eye (DEQ5 and OSDI) and standardized assessments of pain (NRS, NPSI) that we previously found could characterize ocular complaints 21 and predicted a more severe and persistent dry eye course. 8, 22 In this way, our research can be translated to other populations in which these standard dry eye metrics are used, but also specifically assesses subjective metrics that we believe are important in evaluating corneal somatosensory function.…”

Neuropathic symptoms of the ocular surface: dryness, pain, and itch

“…The short-form McGill Pain Questionnaire (sf-MPQ) [17] characterizes the severity (mild, moderate, severe) and quality of pain using 15 descriptors (throbbing, shooting, stabbing, sharp, cramping, gnawing, hot-burning, aching, heavy, tender, splitting, tiring-exhausting, sickening, fearful, and/or punishing-cruel). In our predominantly male veteran population, 82% of individuals with DE symptoms (dry eye questionnaire ≥6) reported one or more of these qualities when describing their eye symptoms [4], The most common descriptors were “tiring-exhausting” (56%), “aching” (56%), and “hot burning” (53%) [4], Using a modified version of the Neuropathic Pain Symptom Inventory [18] (NPSI-Eye), we found that both spontaneous and evoked pain were frequent complaints in our cohort with DE symptoms [4], Specifically, patients frequently reported evoked pain to wind and light [19]. In 220 subjects with mild or greater DE symptoms, 161 individuals (73%) reported pain sensitivity to light, with 94 (43%) rating the sensitivity as moderate-severe (≥4 on scale of 0-10).…”

“…Furthermore, when asked to characterize their ocular sensations, many individuals use additional descriptors, beyond dryness, to describe ocular symptoms. These include both spontaneous sensations such as burning, aching, and tenderness and evoked sensations such as pain in response to light and wind [4]. Notably, sensory descriptors applied by patients with DE resemble those applied by patients with painful peripheral neuropathies [1, 5, 6].…”

Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans

“…Central sensitisation is a prolonged but potentially reversible increase in excitability and synaptic efficiency in central nociceptive pathways 35. Many findings seen in central sensitisation have been described in DE, including patients’ reported complaints that are similar to those in patients with neuropathic pain, that is, ‘burning’ ocular pain, and allodynia and hyperalgesia evoked pain to wind and light22 especially in the subpopulation of DE patients that have discordance of signs and symptoms 11 36…”