期刊
PAIN MEDICINE
卷 17, 期 4, 页码 746-755出版社
OXFORD UNIV PRESS
DOI: 10.1093/pm/pnv070
关键词
Dry Eye; Cornea; Neuropathic Pain; Neuronal Dysfunction; Hyperalgesia; Sensitization
资金
- Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research and Development's Career Development Award [CDA-2-024-10S]
- NIH Center Core Grant [P30EY014801]
- Research to Prevent Blindness Unrestricted Grant
- Department of Defense (DOD) [W81XWH-09-1-0675, W81XWH-13-1-0048 ONOVA]
- NIH NIDCR [R01 DE022903]
Objective. Dry eye is a multi-factorial disorder that manifests with painful ocular symptoms and visual disturbances, which can only be partly attributed to tear dysfunction. This disorder may also involve neuroplasticity in response to neuronal injury. This review will emphasize the key characteristics of dry eye pain and its pathologic mechanisms, making the argument that a subset of dry eye represents a neuropathic pain disorder of the eye, more appropriately called burning eye syndrome. Methods. A literature review was conducted using a PubMed search focusing on dry eye, corneal nociception, and neuropathic pain. Articles were reviewed and those discussing clinical course, pathophysiology, and neuronal regulation of chronic ocular pain as related to dry eye were summarized. Results. We found that there is a discordance between ocular pain and dryness on the ocular surface. Although tear dysfunction may be one of the initial insults, its persistence may be associated with repeated ocular sensory nerve injury leading to an acute-to-chronic pain transition associated with neuropathologic changes (peripheral and central sensitization), neuronal dysfunction, and spontaneous ocular pain. Conclusion. Dry eye is becoming a major health concern due to its increasing incidence, significant morbidity, and economic burden. Recent evidence suggests that a subset of dry eye may be better represented as a chronic neuropathic pain disorder due to its features of dysesthesia, spontaneous pain, allodynia, and hyperalgesia. Future therapies targeted at the underlying neuroplasticity may yield improved efficacy for patients with this subset of dry eye, which we term burning eye syndrome..
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