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Ocular neuropathic pain.

Perry Rosenthal1, David Borsook2

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The British Journal of Ophthalmology
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Neuropathic pain, including dry eye disease, arises from dysfunctional pain signaling. Understanding the eye's unique pain system offers new insights into treating chronic eye pain and related disorders.

Keywords:
CorneaOcular surfaceTears

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Pain Medicine

Background:

  • Pain is a survival mechanism, but neuropathic pain results from a dysfunctional nociceptive system.
  • The eye possesses a specialized trigeminal sensory network to maintain the optical tear film, crucial for vision.
  • Corneal damage can trigger neuropathic pain, leading to conditions like dry eye disease and oculofacial neuropathic pain syndrome.

Purpose of the Study:

  • To explore the neuroscience of chronic eye pain, including dry eye disease.
  • To re-evaluate inadequately explained chronic eye pain through a neuroscience lens.
  • To identify new therapeutic strategies for refractory eye pain disorders.

Main Methods:

  • Review and synthesis of existing research on pain pathways and the trigeminal sensory network.
  • Neuroscience-based analysis of ocular pain mechanisms.
  • Comparison of ocular neuropathic pain with somatic neuropathic pain.

Main Results:

  • Ocular pain, including dry eye, can manifest as neuropathic pain due to trigeminal pathway dysfunction.
  • Oculofacial neuropathic pain syndrome presents with severe symptoms but few external signs, mirroring somatic neuropathic pain.
  • The complex interplay between corneal integrity and the trigeminal system underlies these conditions.

Conclusions:

  • Viewing dry eye and chronic eye pain through a neuroscience framework clarifies their mechanisms.
  • This perspective may lead to novel preventive and therapeutic interventions for currently untreatable eye pain disorders.
  • Further research into the trigeminal sensory network's role in ocular surface homeostasis and pain is warranted.