Concurrent ocular pain in patients with neurotrophic keratopathy.

Published on Aug 17, 2021in Ocular Surface12.336
· DOI :10.1016/J.JTOS.2021.08.003
Leyla Yavuz Saricay (Tufts University), Betül N. Bayraktutar4
Estimated H-index: 4
(Tufts University)
+ 1 AuthorsPedram Hamrah46
Estimated H-index: 46
(Tufts University)
PURPOSE To illustrate that ocular pain may occur in patients with neurotrophic keratopathy (NK) that typically are thought to lack symptoms of discomfort, and that aa subset of these patients may also present with neuropathic corneal pain (NCP). METHOD Retrospective Case series of 7 stage 1 NK patients who presented with concurrent ocular pain, as confirmed by clinical examination, proparacaine challenge test, and in vivo corneal confocal microscopy (IVCM). Records were assessed for results of ocular surface disease index (OSDI), pain on visual analog scale (VAS), ocular pain assessment survey (OPAS), best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, and IVCM findings. IVCM findings were compared to that of 20 healthy reference controls. RESULTS Mean age of patients was 63.7 ± 11.6 (range 44-76) years and 56.9 ± 8.6 (range 42-74) years in reference controls (p = 0.11). At presentation, ocular discomfort was 8.0 ± 1.3 (range 7-10) on VAS and mean OSDI scores were 72.26 ± 6.81 (range 62.50-79.54). Mean BCVA was 20/40, and mean CFS scores were 3.43 ± 0.79 (range 2-4) on the Oxford scale. IVCM analysis showed significant decrease in mean total, main and branch nerve densities in ranges consistent with NK as compared to normal controls (p < 0.001 for all), increased dendritiform cell density in three patients (p < 0.001), and the presence of microneuromas in six of the patients. CONCLUSION Patients with NK are thought to present with hypoesthesia. However, nerve damage and inflammation, which play a role in the development of NK may result in the development of chronic ocular pain, such as NCP, resulting in potential underdiagnosis of either disease.
#1Hamid-Reza Moein (Tufts University)H-Index: 9
#2Anam Akhlaq (Tufts University)H-Index: 5
Last. Pedram Hamrah (Tufts University)H-Index: 46
view all 11 authors...
Abstract Purpose The diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivo confocal microscopy (IVCM). Methods This was a comparative, retrospective, case-control study. Patients with clinical diagnosis of NCP (n = 25),...
8 CitationsSource
#1Ryan J Diel (VA: United States Department of Veterans Affairs)H-Index: 1
#2Jodi Hwang (UM: University of Miami)H-Index: 2
Last. Anat Galor (VA: United States Department of Veterans Affairs)H-Index: 37
view all 9 authors...
Background To evaluate the efficacy of botulinum toxin A (BoNT-A) in reducing photophobia and dry eye symptoms in individuals with chronic migraine. Additionally, we aimed to evaluate tear film volume as a potential contributor to symptoms in these patients. Methods Retrospective review of 76 patients who received BoNT-A for chronic migraine between 23 August 2017 and 13 December 2017 at the Miami Veterans Affairs Medical Center Neurotoxin Clinic. Demographic data and all comorbidities were quer...
12 CitationsSource
#1Majid Moshirfar (UofU: University of Utah)H-Index: 28
#2Erin E. BensteadH-Index: 1
Last. Koushik TripathyH-Index: 1
view all 4 authors...
Ocular neuropathic pain is a diagnosis of exclusion which refers to the heightened perception of pain in response to normally non-painful stimuli. It usually presents without any visible objective exam findings, making it extremely difficult to identify.[1] For this reason, it often gets misdiagnosed as dry eye disease. Ocular neuropathic pain may present with accompanying visible damage to tissue; however, it can also occur as a result of a physiological dysfunction of the nervous system.[1] Wi...
3 Citations
#1Shruti Aggarwal (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 12
#2Clara Colon (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 6
Last. Pedram Hamrah (Tufts University)H-Index: 46
view all 4 authors...
Abstract Objective Corneal nerve damage may result in neuropathic corneal pain (NCP). Autologous serum tears (AST) have been shown to results in nerve regeneration and may help alleviate corneal pain. This study aimed to evaluate the efficacy of AST in the treatment of NCP. Methods This was a retrospective case-control study. Sixteen patients suffering from severe NCP and no current ocular surface disease were compared to 12 controls. In vivo confocal microscopy (IVCM) (HRT3/RCM; Heidelberg Engi...
26 CitationsSource
#1Nurcan Üçeyler (University of Würzburg)H-Index: 50
#2Jan Vollert (RUB: Ruhr University Bochum)H-Index: 15
Last. Claudia Sommer (University of Würzburg)H-Index: 97
view all 9 authors...
AbstractWe assessed pain characteristics and sensory profiles of a large and extensively phenotyped cohort of patients with polyneuropathies (PNPs) and small fiber neuropathy (SFN) using quantitative sensory testing (QST). Our aim was to detect potentially discriminative QST profiles of patient subg
28 CitationsSource
#1Hamid-Reza Moein (Tufts University)H-Index: 9
#2Ahmad Kheirkhah (Harvard University)H-Index: 25
Last. Pedram HamrahH-Index: 46
view all 6 authors...
Abstract Purpose To evaluate the long-term alterations of corneal nerves in patients with herpes simplex virus (HSV) keratitis using in vivo confocal microscopy (IVCM). Design Prospective, longitudinal, cross sectional. Methods This study included 16 patients with a history of HSV keratitis and 15 age-matched normal controls. Slit-scanning IVCM was performed in all subjects at baseline and then after a mean follow-up of 37.3 ± 1.7 months in the patient group. Corneal subbasal nerve density and c...
29 CitationsSource
#1Michael BrinesH-Index: 56
#2Daniel A. Culver (Cleveland Clinic)H-Index: 38
Last. Rayaz A. Malik (Cornell University)H-Index: 80
view all 7 authors...
Small fiber neuropathy (SFN) is a common feature of many inflammatory diseases, often presenting with pain and disability. SFN is diagnosed using symptoms, thermal threshold testing, and intra-epidermal nerve fiber quantification. Corneal confocal microscopy (CCM) is an ophthalmic imaging technique which non-invasively quantifies corneal nerve fiber (CNF) density, branch density and length, and has comparable diagnostic and superior ability to identify nerve regeneration compared to skin biopsy....
45 CitationsSource
#1Bernardo M. Cavalcanti (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 9
#2Andrea Cruzat (MEE: Massachusetts Eye and Ear Infirmary)H-Index: 22
Last. Pedram Hamrah (Tufts University)H-Index: 46
view all 6 authors...
Abstract Purpose To analyze bilateral corneal immune cell and nerve alterations in patients with unilateral herpes zoster ophthalmicus (HZO) by laser in vivo confocal microscopy (IVCM) and their correlation with corneal sensation and clinical findings. Materials and methods This is a prospective, cross-sectional, controlled, single-center study. Twenty-four eyes of 24 HZO patients and their contralateral clinically unaffected eyes and normal controls (n = 24) were included. Laser IVCM (Heidelber...
41 CitationsSource
#1Anat Galor (Bascom Palmer Eye Institute)H-Index: 37
#2Hamid-Reza Moein (Tufts University)H-Index: 9
Last. Roy C. Levitt (UM: University of Miami)H-Index: 44
view all 7 authors...
Abstract Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.
74 CitationsSource
#1Ryan J. Diel (UM: University of Miami)H-Index: 1
#2Zachary A. Kroeger (UM: University of Miami)H-Index: 3
Last. Anat Galor (Bascom Palmer Eye Institute)H-Index: 37
view all 7 authors...
17 CitationsSource
Cited By0