Disruption in Autonomic Nervous Activity Is Associated With Central and Peripheral-Level in Dry Eye With Unstable...

To measure autonomic nerve activity (ANA) in several eye conditions and verify whether ANA modulation is regulated by peripheral or central control in short tear film break-up time dry eye (sBUTDE).

This study included 23 eyes of 23 patients with sBUTDE (mean age 55.2 ± 16.1 years; range 21-88 years) and 24 eyes of 24 age-matched non-dry eye (DE) controls. An ANA measurement, personality questionnaire, and Ocular Surface Disease Index were administered. ANA was continuously measured for 10 minutes under three conditions: eyes closed, eyes open, and eyes open under ocular surface anesthesia.

The low-frequency (LF)/high-frequency (HF) ratio (LF/HF) with eyes closed was significantly higher in the sBUTDE group than in the control group (P < 0.05). In the sBUTDE group, HF increased and LF/HF decreased with eye opening compared with those in the control group; HF with eyes open decreased with ocular surface anesthesia and reached the same level as that in the control group. Among patients where HF decreased or LF/HF increased with eye opening, 57.1% or 64.3% showed a tendency to return to the ANA state with eyes closed by ocular surface anesthesia, respectively. Factors associated with DE symptoms included break-up time, HF with eyes open, and "openness" (P < 0.05).

ANA modulation can be caused by peripheral, central, or mixed abnormalities in sBUTDE. Furthermore, personality traits may play a role in symptom induction. Understanding the pathogenesis of sBUTDE may aid in the treatment of cases that are refractory to conventional treatments.