Br J Ophthalmol doi:10.1136/bjophthalmol-2014-306057
  • Clinical science

Dry eye symptom severity and persistence are associated with symptoms of neuropathic pain

  1. Roy C Levitt1,4,5,7
  1. 1Miami Veterans Administration Medical Center, Miami, Florida, USA
  2. 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  3. 3Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
  4. 4John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
  5. 5John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
  6. 6Departement of Ophthalmology, Washington University School of Medicine, St Louis, Missouri, USA
  7. 7Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Anat Galor, Department of Ophthalmology, Miami VA Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA; agalor{at}
  • Received 26 August 2014
  • Revised 24 September 2014
  • Accepted 5 October 2014
  • Published Online First 21 October 2014


Objective Studies of patients with non-ocular pain suggest that it is therapeutically useful to identify those with features of neuropathic pain. No data is available, however, on whether this approach has similar utility in dry eye. The purpose of this study was to determine whether severity and persistence of dry eye symptoms associate with self-reported symptoms of neuropathic ocular pain (NOP).

Methods Design: Cohort study. Participants/setting: 102 men seen in the Miami Veterans Affairs eye clinic. A baseline evaluation was performed consisting of the dry eye questionnaire 5 (DEQ5) and ocular surface evaluation. Patients were contacted ≥2 years later to repeat the DEQ5 and complete questionnaires that further characterised their eye pain. Main outcome measure: The relationship between dry eye symptom severity and persistence (DEQ5) and additional measures of ocular pain (NOP).

Results Of 102 patients with variable dry eye symptoms, 70 reported at least mild symptoms on both encounters (DEQ5≥6). Fifty-four of 70 (77%) reported ≥1 NOP feature, and the number of NOP features correlated moderately with dry eye symptoms at both encounters (r=0.31–0.46, p<0.01). Patients with any symptom of NOP had higher dry eye symptom scores at both encounters (p<0.05), but similar ocular surface parameters. Hypersensitivity to wind and photoallodynia were associated with having mild or greater symptoms on both encounters (OR 3.4, 95% CI 1.2 to 10.0, p=0.02; OR 15.6, 95% CI 2.0 to 123, p=0.009, respectively).

Conclusions NOP features are common in patients with symptomatic dry eye and these features correlate with symptom severity and persistence.

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