Hyperalgesia and allodynia eye pain in dry eye disease and sicca syndrome associated with presbyopia and VDT overuse

Session Details

Session Title: Cornea: Medical

Session Date/Time: Tuesday 10/10/2017 | 08:00-10:30

Paper Time: 09:54

Venue: Room 3.6

First Author: : E.Mai TAIWAN

Co Author(s): :    D. Chang                    

Abstract Details

Purpose:

To investigate the causal relationship of eye pain in dry eye patients with presbyopic refractive error in overuse VDT work condition. Hyperalgesia is an increase response to a stressful/ noxious stimulus whereas allodynia is a painful response to a normally innocuous stimulus. Our hypothesis state that Dry eye and Sicca syndrome with upregulated inflammatory cytokine in the eye has pre-sensitized the nociceptor nerve fiber in the cornea and orbit, therefore the normally innocuous effort of accommodation and ciliary muscle contraction produce intolerable retro-orbital eye pain, driving the patients to seek medical attention.

Setting:

Teaching hospital clinical observational study. Far Eastern Memorial Hospital, Ophthalmology department

Methods:

61 patients from Dry eye clinic of a teaching hospital were recruited into an observational study. Sicca syndrome where established by blood marker finding and oral mucosal biopsy and oph exam. Dry eye disease where established by traditional methods of Schirmer's test, Cornea dye staining, TBUT, and follow up with OSDI. VDT usage obtain by questionnaire. The eye pain where follow up with PI (pain index). Hyperopic/Presbyopic corrective glasses where prescript with full mydriatic refraction and fogging up to the minimum minus refraction necessary to reach BCVA, patients were follow up with OSDI/ PI/ and other dry eye indexes.

Results:

The OSDI shows improvements of symptom as soon as 1 week after proper refracted glasses usage. Data analysis show significant improvement in OSDI and pain index PI (pain index, Universal pain assessment tool of 1-10), with the average improvement of OSDI up to 27.49 data point (OSDI 0-100) and average pain index (0-10) improvement of 44.76%. In one case, the pain index drop from 8 to 1 in one month follow up. Statistic calculation with graphic lowering of index will be given. Comparison of pre and post treatment shows significant improvement of eye pain, and dry eye index.

Conclusions:

We have previously proved that the risk of having dry eye disease is much higher if the patient had presbyopic refractive errors in an epidemiology study. Clinical follow up of dry eye patients with aggressive treatment of refractive error such as use of full corrective glasses show an improvement of OSDI and Pain index. We proposed that this out of propotional eye pain are due to presensitized nociceptor nerve fiber from the dry eye cornea injury, and can be treated with appropriate refractive correction. In VDT user, computer glass should be an option of treatment recommendation in dry eye patient.

Financial Disclosure:

NONE