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Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease
  1. Ashley M Crane1,2,
  2. Roy C Levitt1,3,4,5,
  3. Elizabeth R Felix1,6,
  4. Konstantinos D Sarantopoulos1,3,
  5. Allison L McClellan1,
  6. Anat Galor1,2
  1. 1Miami Veterans Administration Medical Center, Miami, Florida, USA
  2. 2Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  3. 3Department of Anesthesiology, Perioperative Medicine and Pain Management, 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. 6Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Anat Galor, 900 NW 17th Street, Miami, FL 33136, USA; agalor{at}


Objective To study chronic pain and mental health profiles in patients with dry eye (DE) symptoms, comparing those with high and low levels of neuropathic ocular pain (NOP) complaints.

Design Cross-sectional study of 181 patients with DE symptoms (dry eye questionnaire score ≥6) seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP complaints (burning, sensitivity to wind, light and cold/hot temperatures) and pain elsewhere in the body (non-ocular). This was followed by a comprehensive ocular surface examination. The patients' comorbidities, medications, mental health (depression and post-traumatic stress disorder) and quality-of-life indices were also obtained. Patients were classified using cluster analysis into either the ‘high NOP’ or ‘low NOP’ group. Subsequent analyses were performed to examine differences in ocular and non-ocular parameters between these two groups.

Results Despite similar ocular surface findings, patients in the high NOP group had very different systemic (non-ocular) profiles with higher overall pain intensity ratings, higher frequency of comorbid chronic centralised pain conditions, lower quality-of-life indices and more abnormal mental health scores than those in the low NOP group.

Conclusions Consistent with a chronic overlapping pain condition, patients with DE disease with more severe NOP symptoms report more frequent and severe non-ocular functional comorbid pain disorders.

  • Cornea
  • Inflammation
  • Ocular surface
  • Tears

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  • Contributors Design and conduct of the study: RCL, ERF, KDS, ALMcC and AG; collection: AG; management: AG; analysis: AMC and AG; interpretation of the data: AMC, RCL, ERF, KDS, ALMcC and AG; preparation: AMC, RCL and AG; review or approval of the manuscript: AMC, RCL, ERF, KDS, ALM and AG.

  • Funding The financial and material support of this paper comes from the 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 (AG), NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (DOD-grant# W81XWH-09-1-0675 and grant# W81XWH-13-1-0048 ONOVA) (institutional); NIH NIDCR RO1 DE022903 (RCL), and the Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA.

  • Disclaimer The contents of this study do not represent the views of the Department of Veterans Affairs or the US government.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Miami VAMC, Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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