Antidepressant medication tied to ocular pain severity in dry eye disease
A large proportion of patients with dry eye disease (DED) may experience some degree of ocular pain, and the severity of such pain correlates with nonocular factors such as antidepressant medication use rather than with clinical signs of DED, a study has shown.
The cross-sectional study included 84 DED patients who reported ocular pain. They were asked to score the severity level of their pain using a 10-point scale, with 10 indicating the greatest severity. In addition, ophthalmic assessments including a detailed history, Ocular Surface Disease Index (OSDI) questionnaire and ocular surface examination, were performed.
Based on patient data, the mean OSDI score was 45.6. Of the patients, 88.1 percent reported having at least some degree of ocular pain (score >1)—including mild pain (scores 2 to 4) in 46.4 percent, moderate pain (scores 5 to 7) in 34.5 percent and severe pain (scores 8 to 10) in 7.1 percent. There was a significant correlation between ocular pain levels and the OSDI score (p<0.001).
Regression analysis found the severity of ocular pain to be significantly associated with use of antidepressant medications (p=0.045) but not with tear break-up time, corneal fluorescein staining or ocular medications used by patients.
Among patients who did not report pain, a significant correlation was noted between OSDI and corneal fluorescein staining scores (p=0.01). This correlation was not observed among those with ocular pain.
A common disorder affecting millions of individuals worldwide, DED is characterized by symptoms of ocular discomfort and visual disturbances, as well as variable signs including tear film and ocular surface disruption and inflammatory changes. [J Pain 2016;17:310–318]
Additional evidence suggests that some forms of DED represent a central disorder. Similar to other chronic pain syndromes (CPS), DED is also shown to have a strong association with depression, post-traumatic stress disorder and sleep disruption. Data from previous studies indicate that somatic and structural comorbid CPS, including DED, might share common genetic mechanistic factors. [Sleep Med Rev 2013;17:173-183; Am J Ophthalmol 2012;154:340-346.e342; Ann Hum Genet 2014;78:357-366; Pain 2014;155:1562-1568]