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Corneal sub-basal nerve plexus microneuromas in individuals with and without dry eye
  1. Harrison Dermer1,
  2. Jodi Hwang1,
  3. Rhiya Mittal1,
  4. Adam K Cohen2,
  5. Anat Galor2,3
  1. 1Miller School of Medicine, University of Miami, Miami, Florida, USA
  2. 2Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA
  3. 3Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA
  1. Correspondence to Dr Anat Galor, Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL 33136, USA; agalor{at}


Background/aim An objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.

Methods This was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ2 analyses and Pearson’s correlation coefficients with 0.05 alpha level.

Results MN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).

Conclusion MN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.

  • cornea
  • diagnostic tests/Investigation
  • imaging

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  • Funding Supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (Dr Galor) and Biomedical Laboratory R&D Service I01 BX004893 (Dr Galor), Department of Defense Gulf War Illness Research Program W81XWH-20-1-0579 (Dr Galor) and Vision Research Program W81XWH-20-1-0820 (Dr Galor), National Eye Institute R01EY026174 (Dr Galor) and R61EY032468 (Dr Galor), NIH Center Core Grant P30EY014801 (institutional) and Research to Prevent Blindness Unrestricted Grant (institutional).

  • Disclaimer The views expressed in this work are not an official position of the Veterans Health Administration.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Miami Veterans Administration institutional review board approved the retrospective examination of patients for this study, which was conducted in accordance with the principles of the Declaration of Helsinki and complied with the requirements of the US Health Insurance Portability and Accountability Act.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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