Melik Parsadaniantz Stéphane, Rostène William, Baudouin Christophe, Réaux-Le Goazigo Annabelle
Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France.
Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France - Département d'Ophtalmologie III, Hôpital National des Quinze-Vingts, Paris, France - Département d'Ophtalmologie, Hôpital Ambroise Paré, APHP, Université de Versailles Saint-Quentin en Yvelines, Versailles, France.
Biol Aujourdhui. 2018;212(1-2):1-11. doi: 10.1051/jbio/2018017. Epub 2018 Oct 26.
Dry eye disease (DED) is a common chronic condition with multifactorial etiologies that is increasing in prevalence worldwide, up to 20% in the elderly. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable. Chronic ocular pain is the most common symptom of DED and there is currently no topical ocular analgesic therapy available to treat this debilitating disease. Eye pain can be perceived as itch, irritation, dryness, grittiness, burning, aching, and light sensitivity. Ocular pain is triggered by corneal nociceptors (cornea being the most sensory innervated tissue of the body). It was clearly established that repeated direct damage to ocular surface and per se corneal nerves can cause peripheral and central sensitization mechanisms explaining the ocular pain in some patients with DED. However, the brain regions and the neuronal pathways associated with ocular pain are still unclear. Thus, a better characterization of chronic ocular pain and an understanding of the peripheral and central molecular and cellular mechanisms involved are crucial issues for developing effective management and therapeutic strategy to alleviate ocular pain. In this review, we first describe the nociceptive corneal nerve pathways and the classification and the neurochemistry of primary afferents innervating the cornea. Then, an update of the fundamental and clinical studies related to the inflammatory processes linked to ocular pain is detailed. The last part of the review presents the diagnostic tools used in clinic for evaluating corneal sensitivity and corneal inflammation.
干眼疾病（DED）是一种常见的慢性疾病，病因多因素，在全球范围内患病率不断上升，老年人中高达20%。DED的经济负担以及对视力、生活质量、工作效率、疼痛的心理和生理影响都相当大。慢性眼痛是DED最常见的症状，目前尚无局部眼用镇痛疗法可用于治疗这种使人衰弱的疾病。眼痛可表现为瘙痒、刺激感、干涩感、异物感、烧灼感、疼痛感和畏光。眼痛由角膜伤害感受器触发（角膜是人体感觉神经支配最丰富的组织）。已明确反复直接损伤眼表及角膜神经本身可导致外周和中枢敏化机制，这解释了一些DED患者的眼痛。然而，与眼痛相关的脑区和神经通路仍不清楚。因此，更好地描述慢性眼痛并了解所涉及的外周和中枢分子及细胞机制，是制定有效管理和治疗策略以减轻眼痛的关键问题。在本综述中，我们首先描述伤害感受性角膜神经通路以及支配角膜的初级传入神经的分类和神经化学。然后，详细介绍与眼痛相关炎症过程的基础和临床研究的最新情况。综述的最后一部分介绍了临床上用于评估角膜敏感性和角膜炎症的诊断工具。
