Inadequately Explained Chronic Dry Eye Symptoms and Corneal Pain: New Insights and Concepts

Abstract

We argue that inadequately explained chronic dry eye-like symptoms reflect corneal hypersensitivity to tear evaporation (evaporative hyperalgesia) and those associated with the spectrum of disorders currently labeled as dry eye disease are consequences of neuropathic disorders of the corneal trigeminal nociceptive pathways in which clinical manifestations are determined by the location and downstream effects of its dysfunctional elements.

Read more...

When “Dry Eye” Isn’t Dry: Tears Are Not Always the Explanation

Dry Eye Disease is the diagnosis given to eyes that feel unusually dry, whether or not they are dry. Dry eye symptoms are a unique type of pain that originates in the nerves of the highly sensitive cornea, the dome-shaped, transparent front surface of our eyes behind which our colored iris and black pupil are […]

Read more...

Dry Eye Disease and the Dark Side of Medicine

Dry eye disease (DED) is a major public health problem. Dry eye disease has been estimated to impact the lives of 15-30 million people in the U.S. alone.  These numbers are growing as are its enormous, personal, societal and economic costs.  Therefore, it is baffling that despite the seemingly obvious cause and effect and the […]

Read more...

Chronic Eye Pain Following Laser Keratorefractive Surgery*

Conclusions: The duration of centralized corneal neuropathic pain exceeded 2 years at the time of the initial consultation in all patients. This cohort consisted of 15 women and 6 men. 62% of patients reported a pain-free interval between the resolution of surgical pain and onset of chronic corneal pain that ranged from 3 days to 15 years. Excluding the 15 year outlier, the median delay in the onset of chronic pain following LKS was 1.5 years. 14 of 17 patients who had worn soft contact lenses prior to surgery had developed intolerance to these devices. Of the 4 patients without a prior history of soft contact lens wear, 2 reported notable chronic pre-operative dry eye-like symptoms prior to surgery. 3 of the 15 female patients in this cohort were subsequently diagnosed with Sjogren’s syndrome. Extensive corneal axotomies associated with laser keratorefractive procedures can trigger a chronic pain syndrome consistent with centralized neuropathic corneal pain which is distinct from that characterized by common post-operative dry eye-like symptoms that typically resolve within a year. The disease can transition seamlessly from post-operative physiological pain or commence after a pain-free interval. The recognition that centralized neuropathic corneal pain can be a complication of laser keratorefractive surgery is the first step to developing appropriate mechanism-based treatments for this overlooked, crippling and currently intractable neurological complication.

Read more...