Ocular neuropathic pain is a spectrum of disorders of ocular pain which are caused by damage or disease affecting the nerves. Ocular neuropathic pain is frequently associated with damaged or dysfunctional corneal nerves,[1] but the condition can also be caused by peripheral or centralized sensitization.[2] The condition shares some characteristics with somatic neuropathic pain[2] in that it is similarly associated with abnormal sensations (dysesthesia) or pain from normally non-painful stimuli (allodynia), but until recent years has been poorly understood by the medical community, and frequently dismissed by ophthalmologists who were not trained to identify neuropathic pain as a source of unexplained eye pain beyond objective findings noted on slit-lamp examination.[1]
This condition is frequently associated with dry eye disease since sensations of dryness and burning in the eye are a common symptom of both neuropathic eye pain and dry eye, but ocular neuropathic pain should be considered as a disease in its own right.[2] Neuropathic pain patients may have little or no signs of aqueous dry eye, and frequently respond poorly to conventional dry eye treatments.[3] Unlike conventional dry eye disease, there may be little or no sign of ocular surface damage, (the condition is sometimes referred to as "pain without stain"[3]), however patients may also have symptoms of dry eye but with pain symptoms that are out of proportion to the dry eye presentation.[1]
The experience of painful sensations in this condition can vary widely, reflecting a variety of causal factors such as: types of noxious stimuli causing insult to ocular surface nociceptors, the types of corneal sensory receptors affected, (including cold-sensing thermoreceptors, mechanoreceptors, and polymodal receptors), the extent of the inflammatory responses, and the type or types of disorders and damage affecting the nervous system.[4]
^ abc"Addressing the Pain of Corneal Neuropathy". American Academy of Ophthalmology. July 2010. Retrieved 2018-04-16.
^ abcRosenthal, Perry; Borsook, David (2016). "Ocular neuropathic pain". British Journal of Ophthalmology. 100 (1): 128–134. doi:10.1136/bjophthalmol-2014-306280. PMC 4717373. PMID 25943558.
^ ab"Pain without stain poses diagnostic and therapeutic dilemma". Retrieved 2018-04-16.
^Kalangara, Jerry P.; Galor, Anat; Levitt, Roy C.; Felix, Elizabeth R.; Alegret, Ramon; Sarantopoulos, Constantine D. (2015). "Burning Eye Syndrome: Do Neuropathic Pain Mechanisms Underlie Chronic Dry Eye?". Pain Medicine. pp. 746–755. doi:10.1093/pm/pnv070. PMC 6281056. PMID 26814296. {{cite web}}: Missing or empty |url= (help)
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