IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.
IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, Valladolid, Spain.
Ocul Surf. 2022 Oct;26:63-74. doi: 10.1016/j.jtos.2022.07.010. Epub 2022 Aug 5.
To describe the clinical characteristics of patients suffering from chronic dry eye (DE) and pain after refractive surgery (RS).
Cross-sectional, observational, single-visit study. DE-, pain- and psychological-related symptoms were evaluated with specific questionnaires. DE-related tests evaluated tear osmolarity, conjunctival hyperemia, Meibomian gland dysfunction, tear stability and production, and ocular surface staining. Corneal mechanical sensitivity (Cochet-Bonnet) was measured pre/post topical anesthesia, and symptomatic variation post-anesthesia (anesthetic challenge test) was recorded. When pain was present, it was further categorized as neuropathic or nociceptive based on published criteria.
We recruited 104 patients (39.5 ± 9.5 years). Most, 85.6%, had corneal RS as opposed to intraocular RS. Migraines, anxiety, depression (p < 0.0001), and central sensitization syndromes (p = 0.0214) were more frequent post-RS than pre-RS. Persistent DE-symptoms, severe in 86.5% patients, developed in a range of 0-204 months post-RS. Dryness and pain were the two most frequent symptoms. The only DE-related tests showing abnormal values were tear osmolarity (315.2 ± 17.1 mOsm/L; normal ≤308) and tear break-up time (4.1 ± 2.5 s; normal >7). Corneal sensitivity was 55.4 ± 7.0 mm, and decreased (p < 0.0001) after topical anesthesia, 6.0 ± 10.4 mm. However, it remained pathologically elevated, ≥10 mm in 61 (58.7%) patients. The normal symptomatic post-anesthesia improvement was absent in 58 (55.7%) patients. Ocular pain was present in 82 (78.8%) patients, and it was categorized as neuropathic in 66 (80.5%) of them, 63.5% of the entire cohort.
Chronic ocular pain and its neuropathic subtype were diagnosed in 78.8% and 63.5% respectively of patients seeking consultation for persistent symptomatic DE post-RS.
描述接受屈光手术（RS）后患有慢性干眼症（DE）和疼痛的患者的临床特征。
横断面、观察性、单次就诊研究。使用特定问卷评估 DE、疼痛和心理相关症状。DE 相关测试评估泪液渗透压、结膜充血、睑板腺功能障碍、泪液稳定性和产生以及眼表面染色。在局部麻醉之前和之后测量角膜机械敏感性（Cochet-Bonnet），并记录麻醉后的症状变化（麻醉挑战测试）。当存在疼痛时，根据已发表的标准进一步将其分为神经病理性或伤害感受性疼痛。
我们招募了 104 名患者（39.5±9.5 岁）。大多数（85.6%）患者接受的是角膜 RS，而非眼内 RS。偏头痛、焦虑、抑郁（p<0.0001）和中枢敏化综合征（p=0.0214）在 RS 后比 RS 前更为常见。86.5%的患者出现了持续的 DE 症状，症状严重，发病时间为 RS 后 0-204 个月。干燥和疼痛是最常见的两种症状。唯一显示异常值的 DE 相关测试是泪液渗透压（315.2±17.1 mOsm/L；正常值≤308）和泪膜破裂时间（4.1±2.5 s；正常值>7）。角膜敏感性为 55.4±7.0 mm，局部麻醉后下降（p<0.0001），为 6.0±10.4 mm。然而，它仍然病理性升高，61 名（58.7%）患者的角膜敏感性≥10mm。58 名（55.7%）患者的正常麻醉后症状改善缺失。82 名（78.8%）患者存在眼部疼痛，其中 66 名（80.5%）患者为神经病理性疼痛，整个队列中有 63.5%为神经病理性疼痛。
在因接受 RS 后持续性有症状的 DE 而就诊的患者中，分别有 78.8%和 63.5%被诊断为慢性眼部疼痛及其神经病理性亚型。
