PT  - JOURNAL ARTICLE
AU  - Ryan J Diel
AU  - Divy Mehra
AU  - Randy Kardon
AU  - Dawn C Buse
AU  - Eric Moulton
AU  - Anat Galor
TI  - Photophobia: shared pathophysiology underlying dry eye disease, migraine and traumatic brain injury leading to central neuroplasticity of the trigeminothalamic pathway
AID  - 10.1136/bjophthalmol-2020-316417
DP  - 2021 Jun 01
TA  - British Journal of Ophthalmology
PG  - 751--760
VI  - 105
IP  - 6
4099  - http://bjo.bmj.com/content/105/6/751.short
4100  - http://bjo.bmj.com/content/105/6/751.full
SO  - Br J Ophthalmol2021 Jun 01; 105
AB  - Background Photophobia is a potentially debilitating symptom often found in dry eye disease (DE), migraine and traumatic brain injury (TBI).Methods We conducted a review of the literature via a PubMed search of English language articles with a focus on how photophobia may relate to a shared pathophysiology across DE, migraine and TBI.Results DE, migraine and TBI are common conditions in the general population, are often comorbid, and share photophobia as a symptom. Across the three conditions, neural dysregulation of peripheral and central nervous system components is implicated in photophobia in various animal models and in humans. Enhanced activity of the neuropeptide calcitonin gene-related peptide (CGRP) is closely linked to photophobia. Current therapies for photophobia include glasses which shield the eyes from specific wavelengths, botulinum toxin, and inhibition of CGRP and its receptor. Many individuals have persistent photophobia despite the use of these therapies, and thus, development of new therapies is needed.Conclusions The presence of photophobia in DE, migraine and TBI suggests shared trigeminothalamic pathophysiologic mechanisms, as explained by central neuroplasticity and hypersensitivity mediated by neuropeptide CGRP. Treatment strategies which target neural pathways (ie, oral neuromodulators, transcutaneous nerve stimulation) should be considered in patients with persistent photophobia, specifically in individuals with DE whose symptoms are not controlled with traditional therapies.