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Original Investigation | Clinical Sciences

Relationship Between Dry Eye Symptoms and Pain Sensitivity

Jelle Vehof, PhD1,2; Diana Kozareva1; Pirro G. Hysi, PhD1; Juliette Harris, PhD1; Ayrun Nessa1; Frances K. Williams, PhD1; David L. H. Bennett, PhD3; Steve B. McMahon, PhD3; Samantha J. Fahy, PhD1,4; Kenan Direk, MSc1; Tim D. Spector, PhD1; Christopher J. Hammond, PhD1,5
[+] Author Affiliations
1Department of Twin Research & Genetic Epidemiology, King’s College London, St Thomas’ Hospital, Waterloo, London, England
2Department of Ophthalmology & Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
3Wolfson Centre for Age-Related Diseases, King’s College London, London, England
4Division of Primary Care, University of Nottingham, University Park, Nottingham, England
5Department of Ophthalmology, King’s College London, St Thomas’ Hospital, London, England
JAMA Ophthalmol. 2013;131(10):1304-1308. doi:10.1001/jamaophthalmol.2013.4399.
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Importance  Dry eye disease (DED) is common, but little is known about factors contributing to symptoms of dry eye, given the poor correlation between these symptoms and objective signs at the ocular surface.

Objective  To explore whether pain sensitivity plays a role in patients’ experience of DED symptoms.

Design, Setting, and Participants  A population-based cross-sectional study of 1635 female twin volunteers, aged 20 to 83 years, from the TwinsUK adult registry.

Main Outcomes and Measures  Dry eye disease was diagnosed if participants had at least 1 of the following: (1) a diagnosis of DED by a clinician, (2) the prescription of artificial tears, and/or (3) symptoms of dry eyes for at least 3 months. A subset of 689 women completed the Ocular Surface Disease Index (OSDI) questionnaire. Quantitative sensory testing using heat stimulus on the forearm was used to assess pain sensitivity (heat pain threshold [HPT]) and pain tolerance (heat pain suprathreshold [HPST]).

Results  Of the 1622 participants included, 438 (27.0%) were categorized as having DED. Women with DED showed a significantly lower HPT (P = .03) and HPST (P = .003)—and hence had higher pain sensitivity—than those without DED. A strong significant association between the presence of pain symptoms on the OSDI and the HPT and HPST was found (P = .008 for the HPT and P = .003 for the HPST). In addition, participants with an HPT below the median had DED pain symptoms almost twice as often as those with an HPT above the median (31.2% vs 20.5%; odds ratio, 1.76; 95% CI, 1.15-2.71; P = .01).

Conclusions and Relevance  High pain sensitivity and low pain tolerance are associated with symptoms of DED, adding to previous associations of the severity of tear insufficiency, cell damage, and psychological factors. Management of DED symptoms is complex, and physicians need to consider the holistic picture, rather than simply treating ocular signs.

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