Department of Ophthalmology, Miami VA Medical Center, Miami, Florida, USA.
Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
Br J Ophthalmol. 2018 May;102(5):667-673. doi: 10.1136/bjophthalmol-2017-310509. Epub 2017 Aug 26.
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).
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.
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.
DE and pain disorders occur at higher frequencies in patients with a diagnosis of TBI, suggesting a common underlying pathophysiology.
本研究旨在评估美国有创伤性脑损伤（TBI）和无 TBI 的退伍军人中干眼（DE）与疼痛诊断之间的关系。
这是一项回顾性队列研究，纳入 2010 年 1 月 1 日至 2014 年 12 月 31 日期间在退伍军人事务部医院（VA）就诊的退伍军人。根据是否存在国际疾病分类第 9 版（ICD-9）TBI 诊断，将退伍军人分为两组，并评估 DE 和其他合并症。使用聚类树图来研究 TBI、DE、慢性疼痛和其他合并症之间的联系。
在 5 年期间就诊的 3265894 名退伍军人中，有 3.97%的人诊断为 TBI。与无 TBI 的退伍军人相比，有 TBI 的退伍军人更有可能被诊断为 DE（37.2%比 29.1%，p<0.0005）。与泪膜功能障碍（OR 1.09；95%CI 1.07 至 1.10）相比，TBI 与眼痛之间的相关性更强（OR 3.08；95%CI 3.03 至 3.13）。与无 TBI 的退伍军人相比，有 TBI 的退伍军人患有慢性疼痛、头痛、抑郁或创伤后应激障碍的诊断率也几乎高出两倍。对 TBI、DE 和感兴趣的疼痛诊断进行聚类分析显示，中枢性疼痛综合征、丛集性头痛、干燥综合征、干燥性角结膜炎和神经系统损伤的晚期效应（如 TBI 后可见）均紧密聚集在一起。
在诊断为 TBI 的患者中，DE 和疼痛障碍的发生频率更高，提示存在共同的潜在病理生理学机制。
