The potential role of neuropathic mechanisms in dry eye syndromes

McMonnies, Charles W.

doi:10.1016/j.optom.2016.06.002

Cited by 63 publications

(66 citation statements)

References 59 publications

(125 reference statements)

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“…Recently, the concept of neuropathic pain has emerged as an important factor for dry eye development, and hypersensitivity to the unstable tear film is considered the mechanism underlying dry eye. [30][31][32][33][34][35] Kaido et al 14 reported in 2016 that hypersensitivity of the cornea exists in short TBUT-type dry eye, speculating that the severe symptoms of short TBUT-type dry eye may be due to the neuropathic pain components.…”

Section: History Of the Short Tbut-type Dry Eyementioning

confidence: 99%

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Short Tear Film Breakup Time–Type Dry Eye

Ohta

2018

Invest. Ophthalmol. Vis. Sci.

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Measurement of tear film breakup time (TBUT) has become a standard diagnostic procedure in the dry eye clinic. Short TBUT-type dry eye is characterized by TBUT of less than 5 seconds and dry eye symptoms such as ocular fatigue or dryness; the importance of this type has recently been gaining prominence. Patients with this condition show no reduction in tear production and no staining of the ocular surface. The severity of symptoms is almost the same as in dry eye in which the ocular surface is stained with rose bengal or fluorescein. In addition to discomfort, patients suffer from decreased vision due to the unstable tear film, which can be attributed to the relative abnormality of the lipid layer, aqueous layer, and/or mucin layer. The diagnosis should be performed carefully on the basis of the patient's symptoms and the TBUT test, because the ocular surface appears normal and remains unstained.

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Section: History Of the Short Tbut-type Dry Eyementioning

confidence: 99%

“…58 Galor et al and other groups are exploring multiple treatment approaches in this field, and new developments are expected in the near future. [31][32][33][34][35]…”

Section: Treatment Of Short Tbut-type Dry Eyementioning

confidence: 99%

Short Tear Film Breakup Time–Type Dry Eye

Ohta

2018

Invest. Ophthalmol. Vis. Sci.

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“…[107][108][109][110][111] Furthermore, DED often develops in glaucoma patients, since glaucoma medication is toxic to the ocular surface. 112 Secondly, it is highly likely that pain [113][114][115] in patients with DED may be associated with sleep disorders. Sleep disorders with pain have been suggested in pSS and other rheumatic diseases.…”

Section: Possible Explanation For Sleep Disorders In Dedmentioning

confidence: 99%

Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye

Ayaki

Ohta

Kawashima

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Sleep is an essential life habit and closely associated with lifespan, diabetes, hypertension, and mental health. Sleep disorders are a prominent, but overlooked problem in patients with dry eye disease (DED), characterized by a poor sleep index, short sleep duration, long sleep latency, and poor subjective sleep. DED and sleep disorders are more prevalent in women than men. Moreover, sleep quality in DED is worse than in other eye diseases, including glaucoma, retinal diseases, cataract, and allergic and chronic conjunctivitis. METHODS. We reviewed the literature for studies investigating sleep and health, eyes and sleep, and DED and sleep, in terms of systemic and eye health, especially in women. RESULTS. Two studies reported that approximately half of patients with DED suffer from poor sleep. The severity of mood disorders, including anxiety and depression, is correlated strongly with sleep disorders in DED, and the symptoms and signs of DED, especially pain, also are correlated with sleep quality. Sleep disorders are documented in primary Sjögren's syndrome and an association with sleep apnea and depression is suggested. Primary Sjögren's syndrome includes arthritis and other rheumatic disease causing pain and fatigue; however, how sicca contributes to sleep disorders is not known. CONCLUSIONS. Possible explanations for sleep disorders in DED may be depression, pain, and eye exposure at night. Reciprocal effects may be expected and consultation-liaison psychiatry is recommended for the management of sleep disorders in DED. Topical medication and lid heating also may be advantageous for sleep quality in DED.

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“…For neuropathic pain, considering that pain can become spontaneous and unresponsive to artificial tear instillation once central sensitization develops, limitation of the neuroplastic sensitization process by prevention of ocular surface damage and inflammation in the initial stages would be important 2,21,56,82. Aggressive treatment with anti-inflammatory medications is necessary for relief of acute pain and improvement of ocular surface inflammation 56,82.…”

Section: Managementmentioning

confidence: 99%

“…Although this discrepancy can partly be explained by the limited reliability of the dry eye tests currently available; individual differences in cognitive response to dry eye questionnaires,9 the heterogeneous nature of DED and individual variability in the perception of dry eye symptoms may also play an important role 9. In particular, studies focused on the association of DED with neurological or psychiatric disorders have suggested the role of neurological or psychological factors in the development of dry eye symptoms, particularly in elderly patients 2,12,17–21. Vehof et al17 recently showed that severe dry eye symptoms unproportional to external signs were associated with lower level of self-perceived health.…”

Section: Introductionmentioning

confidence: 99%

Association of dry eye disease with psychiatric or neurological disorders in elderly patients

Han

Yang²,

Hyon³

et al. 2017

CIA

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Dry eye disease (DED) is a common disease that can impair quality of life significantly. Its prevalence increases with advancing age, and the economic burden of the disease on both a patient and the society is increasing with elongation of life expectancy. The diagnosis and treatment of DED are often difficult due to the discordance between symptoms and signs of the disease. Recent studies have suggested the role of neurological or psychological factors in the development of dry eye symptoms and discrepancy of the symptoms and signs, particularly in elderly patients. In this review, the authors discuss the association of DED with various psychiatric and neurological disorders. In addition to psychiatric conditions, including depression, anxiety, stress, posttraumatic stress disorder and sleep disorders, medications for the psychiatric disorders have association with DED. Neurological disorders, such as neuropathic pain, chronic pain syndrome, peripheral neuropathy and several central nervous system disorders, are related to DED. Treatment of DED, combined with psychiatric or neurological disorders, is also discussed. Attention should be paid to the DED patients with discordant symptoms and signs, and unsatisfactory response to conventional treatment for associated psychiatric or neurological disorders, as well as an integrated treatment approach, could be helpful for these patients.

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The potential role of neuropathic mechanisms in dry eye syndromes

Cited by 63 publications

References 59 publications

Short Tear Film Breakup Time–Type Dry Eye

Short Tear Film Breakup Time–Type Dry Eye

Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye

Association of dry eye disease with psychiatric or neurological disorders in elderly patients

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