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Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans
  1. Charity J Lee1,2,
  2. Elizabeth R Felix1,3,
  3. Roy C Levitt1,4,5,6,
  4. Christopher Eddy4,
  5. Elizabeth A Vanner2,
  6. William J Feuer2,
  7. Constantine D Sarantopoulos4,
  8. Anat Galor1,2
  1. 1Department of Ophthalmology, Miami VA Medical Center, Miami, Florida, USA
  2. 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
  3. 3Department of Physical Medicine & Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida, USA
  4. 4Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, Florida, USA
  5. 5Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA
  6. 6Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Anat Galor, Department of Ophthalmology, Miami VA medical center, Miami, FL, USA; agalor{at}


Aims The purpose of the study is to evaluate the relationship between dry eye (DE) and pain diagnoses in US veterans with and without traumatic brain injury (TBI).

Methods Retrospective cohort study of veterans who were seen in the Veterans Administration Hospital (VA) between 1 January 2010 and 31 December 2014. Veterans were separated into two groups by the presence or absence of an International Classification of Diseases, Ninth Revision diagnosis of TBI and assessed for DE and other comorbidities. A dendrogram was used to investigate the linkage between TBI, DE, chronic pain and other comorbid conditions.

Results Of the 3 265 894 veterans seen during the 5-year period, 3.97% carried a diagnosis of TBI. Veterans with TBI were more likely to have a diagnosis of DE compared with their counterparts without TBI (37.2% vs 29.1%, p<0.0005). The association was stronger between TBI and ocular pain (OR 3.08; 95% CI 3.03 to 3.13) compared with tear film dysfunction (OR 1.09; 95% CI 1.07 to 1.10). Those with TBI were also about twice as likely to have a diagnosis of chronic pain, headache, depression or post-traumatic stress disorder compared with their counterparts without TBI. Cluster analysis of TBI, DE and pain diagnoses of interest revealed that central pain syndrome, cluster headache, sicca syndrome, keratoconjunctivitis sicca and late effect of injury to the nervous system (as can be seen after TBI) were all closely clustered together.

Conclusions DE and pain disorders occur at higher frequencies in patients with a diagnosis of TBI, suggesting a common underlying pathophysiology.

  • Ocular Surface
  • Public Health
  • Epidemiology

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  • Contributors Design and conduct of the study: RCL, CDS and AG; collection: CJL, CE and AG; management: AG; analysis: CJL, EAV, WJF and AG; interpretation of the data: CJL, WJF, ERF and AG; preparation: CJL, RCL, EAV, ERF and AG; review or approval of the manuscript: CJL, RCL, CE, EAV, WJF, CDS, ERF and AG.

  • Funding Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences Research EPID-006-15S (AG), NIH Center Core Grant P30EY014801, R01EY026174 (AG), Research to Prevent Blindness Unrestricted Grant, NIH NIDCR RO1 DE022903 (RCL and Martin), Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, Florida.

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

  • Competing interests None declared.

  • Ethics approval Miami VA IRB.

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

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