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Sloesen B, O'Brien P, Verma H, Asaithambi S, Parashar N, Mothe RK, Shaikh J, Syntosi A. Patient Experiences and Insights on Chronic Ocular Pain: Social Media Listening Study. JMIR Form Res 2024; 8:e47245. [PMID: 38358786 PMCID: PMC10905354 DOI: 10.2196/47245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 12/01/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Ocular pain has multifactorial etiologies that affect activities of daily life, psychological well-being, and health-related quality of life (QoL). Chronic ocular surface pain (COSP) is a persistent eye pain symptom lasting for a period longer than 3 months. OBJECTIVE The objective of this social media listening study was to better understand COSP and related symptoms and identify its perceived causes, comorbidities, and impact on QoL from social media posts. METHODS A search from February 2020 to February 2021 was performed on social media platforms (Twitter, Facebook, blogs, and forums) for English-language content posted on the web. Social media platforms that did not provide public access to information or posts were excluded. Social media posts from Australia, Canada, the United Kingdom, and the United States were retrieved using the Social Studio platform-a web-based aggregator tool. RESULTS Of the 25,590 posts identified initially, 464 posts about COSP were considered relevant; the majority of conversations (98.3%, n=456) were posted by adults (aged >18 years). Work status was mentioned in 52 conversations. Patients' or caregivers' discussions across social media platforms were centered around the symptoms (61.9%, n=287) and causes (58%, n=269) of ocular pain. Patients mentioned having symptoms associated with COSP, including headache or head pressure, dry or gritty eyes, light sensitivity, etc. Patients posted that their COSP impacts day-to-day activities such as reading, driving, sleeping, and their social, mental, and functional well-being. CONCLUSIONS Insights from this study reported patients' experiences, concerns, and the adverse impact on overall QoL. COSP imposes a significant burden on patients, which spans multiple aspects of daily life.
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Zhang S, Mi J, Ge S, Wang G, Zhou Z, Zhao Y, Zhao Y. Analysis of clinical characteristics and factors influencing herpes simplex virus keratitis. Front Med (Lausanne) 2024; 10:1267783. [PMID: 38293295 PMCID: PMC10824927 DOI: 10.3389/fmed.2023.1267783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
Objective To investigate the clinical characteristics and factors associated with herpes simplex virus keratitis. Methods Patients with herpes simplex virus keratitis who came to our hospital from January 2018 to June 2022 were selected and divided into a good prognosis group and a poor prognosis group according to their prognosis. The clinical data of the two groups were compared, and univariate/multivariate logistic regression was used to analyze the factors influencing the poor prognosis of herpes simplex virus keratitis. Results A one-way analysis of variance showed that, compared with the good prognosis group, the poor prognosis group had more elderly patients and a longer course of disease, and the difference was statistically significant (p < 0.05). There were significant differences in the types of patients between the two groups (p < 0.05). Univariate logistic regression analysis also showed that age (≥65 years) (OR: 1.557, 95%CI: 1.081-2.183, p < 0.05), course of disease (> 7 months) (OR: 1.303, 95%CI: 1.003-1.829, p < 0.05), epithelial type (OR: 2.321, 95%CI: 1.198-4.321, p < 0.05), and stromal type (OR: 2.536, 95%CI: 1.672-3.871, p < 0.05) were risk factors for poor prognosis. Multivariate logistic regression analysis showed that age (≥65 years) (OR: 1.656, 95%CI: 1.168-2.357, p < 0.05) and course of disease (> 7 months) (OR: 1.461, 95%CI: 1.031-2.001, p < 0.05) were independent risk factors for the prognosis of herpes simplex keratitis. Conclusion The clinical symptoms of herpes simplex virus keratitis include corneal opacity, corneal posterior elastic layer folds, corneal infiltration, posterior corneal mass, corneal edema, and ocular pain. Age and course of disease are important factors in the prognosis of herpes simplex virus keratitis.
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Affiliation(s)
- Shuai Zhang
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinhua Mi
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shengmei Ge
- Intensive Care Medicine, The Forth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guoqiang Wang
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhongyou Zhou
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yantao Zhao
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yan Zhao
- Department of Ophthalmology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Yoshikawa Y, Yokoi N, Kusada N, Kato H, Sakai R, Komuro A, Sonomura Y, Sotozono C. Eye Pain Caused by Epithelial Damage in the Central Cornea in Aqueous-Deficient Dry Eye. Diagnostics (Basel) 2023; 14:30. [PMID: 38201339 PMCID: PMC10802830 DOI: 10.3390/diagnostics14010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
In this study, the severity of eye pain (EP) and associated objective findings were evaluated in aqueous-deficient dry eye (ADDE) patients using PainVision®, a quantitative pain-measuring device. This study involved 53 eyes of 53 ADDE patients (6 males and 47 females; mean age: 64.4 ± 13.4 [mean ± SD] years). Of those, 18 eyes of 18 patients underwent punctal occlusion, and EP and objective findings in those patients were evaluated before and after treatment. In all patients, the severity of EP as measured by PainVision® was assessed using the Pain Degree (PD). The median PD for the 53 patients was 30.6 µA/µA (interquartile range, 16.9-93.2), and the nasal and central corneal staining score and the upper lid-wiper epitheliopathy score were significantly correlated with PD (R = 0.33, 0.33, and 0.28, respectively) (all: p < 0.05). Using the least squares method, the central corneal staining score most significantly affected PD. In the 18 cases that underwent punctal occlusion, PD was significantly reduced (median PD: 24.8 to 7.1 µA/µA; p < 0.0001). Using the least squares method, the central corneal staining score and tear meniscus radius were significantly more influential as factors contributing to PD before and after treatment, and central corneal epithelial damage was the factor most associated with ADDE-related EP.
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Affiliation(s)
- Yamato Yoshikawa
- Department of Ophthalmology, Osaka Medical and Pharmaceutical University, Takatsuki-City 569-8686, Japan;
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Natsuki Kusada
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Rieko Sakai
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Aoi Komuro
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Yukiko Sonomura
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (R.S.); (A.K.); (Y.S.); (C.S.)
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Abdalla WM, Alhalabi R. Chronic Unilateral Idiopathic Trochleitis Misdiagnosed With Migraine in an 18-Year-Old Male: A Case Report. Cureus 2023; 15:e45010. [PMID: 37829996 PMCID: PMC10565604 DOI: 10.7759/cureus.45010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Trochleitis is a very rare form of inflammation that occurs in the trochlear region. It is characterized by periorbital pain, diplopia, blurred vision, frontal headache, trochlear tenderness, and radiologic signs of inflammation. We report a case of an 18-year-old man who experienced unilateral eye pain, double vision, and tenderness when looking upward. Initially, his pain was misdiagnosed as migraine for more than two months. The patient did not show improvement with NSAID treatment, leading to successful treatment with a steroidal injection. Although rare, healthcare providers should maintain a high index of suspicion to avoid misdiagnosis of this type of eye pain.
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Parra-Tanoux D, Dussan-Vargas MP, Escandon MG. Painful-blind eye: A forgotten palliative care. Indian J Ophthalmol 2023; 71:2399-2408. [PMID: 37322649 PMCID: PMC10417970 DOI: 10.4103/ijo.ijo_3063_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.
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Affiliation(s)
- Daniela Parra-Tanoux
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Maria P Dussan-Vargas
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Martha Gonzalez Escandon
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
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Peterson E, Minalyan A, Downey C. Carotid-Cavernous Fistula in a Patient With Unilateral Periorbital Swelling and Proptosis Initially Attributed to Possible Immunoglobulin G4-Related (IgG4-Related) Disease. Cureus 2023; 15:e39608. [PMID: 37384089 PMCID: PMC10299811 DOI: 10.7759/cureus.39608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
The differential diagnosis for proptosis and periorbital swelling is broad and includes infectious, malignant, vascular, and rheumatologic etiologies. In this study, we report a case of carotid-cavernous fistula as the cause of acute-onset unilateral proptosis and periorbital swelling of the right eye in a 44-year-old female patient whose symptoms were initially attributed to possible immunoglobulin G4-related disease (IgG4-RD). The patient initially received antibiotics for presumed cellulitis and steroid treatment for a possible autoimmune cause, however; her autoimmune work-up was negative. Radiologic imaging later confirmed that she had a direct spontaneous carotid-cavernous fistula. She experienced significant improvement in her symptoms and vision after embolization treatment. Due to the risk that a carotid-cavernous fistula will progress quickly and cause neurological damage, this is a key diagnosis that should not be missed in patients with acute-onset periorbital and visual symptoms. Rheumatologists should include this condition in the differential for any patient who presents with periorbital swelling and vision disturbances.
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Affiliation(s)
| | - Artem Minalyan
- Medicine/Rheumatology, Loma Linda University Health, Loma Linda, USA
| | - Christina Downey
- Medicine/Rheumatology, Loma Linda University Health, Loma Linda, USA
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Shetty R, Dua HS, Tong L, Kundu G, Khamar P, Gorimanipalli B, D'Souza S. Role of in vivo confocal microscopy in dry eye disease and eye pain. Indian J Ophthalmol 2023; 71:1099-1104. [PMID: 37026240 DOI: 10.4103/ijo.ijo_3013_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Dry eye disease is known to have a lot of variability in presentation with overlapping subtypes. Understanding the pathology of this condition will guide therapeutic options. In vivo confocal microscopy is a diagnostic and imaging modality that provides high magnification and high-resolution images of all layers of the cornea and ocular surface. Various structures in the cornea and their alterations due to dry eye have been imaged. The impact of the tear film instability, inflammation, and altered homeostasis on the corneal epithelium, nerves, keratocytes, and dendritic cells have been evaluated across different studies. In addition, key features of IVCM in patients with neuropathic pain have been highlighted in this paper.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Harminder S Dua
- Department of Ophthalmology and Visual Sciences, Queens Medical Centre, University of Nottingham, Nottingham, United Kingdom
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of, Singapore
| | - Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Bhavya Gorimanipalli
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bangalore, Karnataka, India
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Mangwani-Mordani S, Goodman CF, Galor A. Novel Treatments for Chronic Ocular Surface Pain. Cornea 2023; 42:261-271. [PMID: 36729473 PMCID: PMC9918665 DOI: 10.1097/ico.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/28/2022] [Indexed: 02/03/2023]
Abstract
ABSTRACT Several etiologies can contribute to ocular surface pain including nociceptive, peripheral neuropathic, and central neuropathic mechanisms. Clinical clues can help identify contributors to ocular surface pain in a patient. In individuals whose pain persists despite targeting nociceptive contributors, neuropathic mechanisms should be considered and addressed using oral, topical, and/or adjuvant agents.
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Affiliation(s)
- Simran Mangwani-Mordani
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 NW 17 Street, Miami, FL, 33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, 900 NW 17 Street, Miami, FL 33136, USA
| | - Courtney F. Goodman
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, 900 NW 17 Street, Miami, FL 33136, USA
| | - Anat Galor
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 NW 17 Street, Miami, FL, 33125, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, 900 NW 17 Street, Miami, FL 33136, USA
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Shen X, Chen X, He Y, Xu H, Zhu J. Efficacy and safety of pregabalin in eye pain: A systematic review. Medicine (Baltimore) 2023; 102:e32875. [PMID: 36820573 PMCID: PMC9907909 DOI: 10.1097/md.0000000000032875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The pregabalin is approved for the management of persistent pain. The aim of this study is to assess the advantages and disadvantages of the use of pregabalin in eye pain management. METHODS The PubMed, Cochrane Library, Embase, and Web of Science databases were searched until January 2022 for randomized controlled trials. Randomized, double-blinded trials comparing pregabalin with placebo in eye pain management were included. The primary outcome was visual analog scale or numerical rating scale at acute (24 hours) and chronic (≥7 days after surgery) timepoints. The secondary outcomes were analgesic medication requirements and pregabalin-related complications (nausea, vomiting, dizziness, and headache). We also compared the effect of pregabalin on dry-eye syndrome. MAIN RESULTS Six relevant articles were identified that studied the use of pregabalin as pain relief for photorefractive keratectomy (n = 2), laser epithelial keratomileusis (n = 1), laser-assisted in situ keratomileusis (n = 1), eyelid surgery (n = 1), and dacryocystorhinostomy (n = 1). Pregabalin was associated with a significant reduction in pain scores (95% confidence interval = -0.41 [-0.76--0.06]) 24 hours after surgical procedures. The data were insufficient to draw conclusions regarding dry eye symptoms. Because of the high heterogeneity of outcomes regarding adverse effects, there is no conclusion regarding the safety of pregabalin in eye pain. CONCLUSIONS Pregabalin reduced acute eye pain but had no significant effect on long-term analgesia after ophthalmological surgery in adults. It had no effect on dry-eye symptoms after ocular surgery. Further studies on the safety of pregabalin in eye pain management are required to draw solid conclusions.
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Affiliation(s)
- Xiaohua Shen
- Department of Pathology and Molecular Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Xingying Chen
- Department of Pathology and Molecular Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Yanyan He
- Department of Pathology and Molecular Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Hui Xu
- Department of Pathology and Molecular Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
| | - Jia Zhu
- Department of Pathology and Molecular Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, Zhejiang, China
- Forensic and Pathology Laboratory, Jiaxing University Medical College, Jiaxing University, Jiaxing, Zhejiang, China
- * Correspondence: Jia Zhu, Forensic and Pathology Laboratory, Jiaxing University Medical College, Jiaxing University, Jiaxing, Zhejiang 314001, China (e-mail: )
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Reynolds MS, Katz BJ, Digre KB, Brintz BJ, Olson LM, Warner JE. Sharp Edge Eye Syndrome: A Case Report and Survey of Self-Identified Individuals. J Neuroophthalmol 2022; 42:524-529. [PMID: 36166802 PMCID: PMC9675685 DOI: 10.1097/wno.0000000000001650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sharp edge eye syndrome (SEES), sometimes known as visual looming syndrome, is a condition in which the patient experiences ocular pain or discomfort when viewing or mentally picturing sharp objects and edges. Patients may present for medical care because they perceive the condition to represent an ophthalmic problem or a sign of a more serious underlying condition. An individual case report of SEES is included to aid in illustrating syndrome characteristics. Our aim is to describe the syndrome, vision-related quality of life (VRQOL), and psychosocial characteristics in patients with self-identified SEES. METHODS A cross-sectional web-based survey was made available on social media webpages dedicated to SEES. The study included 22 questions developed by the research team, demographic questions, and 4 standardized questionnaires [ID Migraine, the National Eye Institute's Visual Function Questionnaire (NEI-VFQ-25), General Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire (depression) Scale-2]. RESULTS Seventy-seven respondents had an average age of 29 and were 57% male. 92% reported symptoms before age 18. The main site of pain or discomfort was the eyes, with onset resulting from viewing or thinking of sharp objects and edges. Symptoms lasted from seconds to hours and could be prolonged even after closing eyes or avoiding viewing the trigger. The composite and subscale scores on the NEI-VFQ-25 were low, with a mean composite score of 78 and selected subscores of general health (61), general vision (73), ocular pain (68), driving (79), mental health (61), and role difficulties (72). Anxiety was reported in 58% of participants, and depression in 57%. Migraine or headache was reported in 46% of participants. Participants reported Alice in Wonderland syndrome, visual snow, obsessive-compulsive disorder, attention deficit hyperactivity disorder, stripe-induced visual discomfort, and synesthesia. CONCLUSION From this survey, we have the beginnings of an understanding of the characteristics of SEES, as well as VRQOL impacts. These survey responses lead us to postulate that SEES may be a distinct visual phenomenon and to propose SEES criteria. Systematic studies of this condition's clinical features and treatment responses will be additional steps toward improving patient care.
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Affiliation(s)
- Merrick S. Reynolds
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Bradley J. Katz
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Kathleen B. Digre
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Ben J. Brintz
- Department of Pediatrics, Division of Critical Care, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Lenora M. Olson
- Department of Internal Medicine, Division of Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Judith E.A. Warner
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Stürmer J. [Ophthalmologic Emergencies in the General Practice]. Praxis (Bern 1994) 2022; 111:687-698. [PMID: 36102023 DOI: 10.1024/1661-8157/a003900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ophthalmologic Emergencies in the General Practice Abstract. Even though ophthalmological care is now very well developed even in rural areas, many patients with an eye problem still consult their family doctor or general internist as a first step. The general internist must then decide on an ad-hoc basis if that he or she can manage the problem with a simple treatment available to him or her (tear substitutes, topical antibiotics or a combination of steroids and antibiotics) or if a referral to the nearest ophthalmologist is necessary.
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Affiliation(s)
- Jörg Stürmer
- Augenklinik, Kantonsspital Winterthur, Winterthur, Schweiz
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12
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Rusciano D, Bagnoli P, Gallar J, Galor A. Editorial: Eye Pain: Etiology and Therapeutic Approaches. Front Pharmacol 2022; 13:914809. [PMID: 35571104 PMCID: PMC9092182 DOI: 10.3389/fphar.2022.914809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, United States
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Goyal L, Ajmera K, Pandit R. Reoccurring Episcleritis and the Role of Antioxidants. Cureus 2022; 14:e24111. [PMID: 35530867 PMCID: PMC9073074 DOI: 10.7759/cureus.24111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/05/2022] Open
Abstract
Episcleritis is an irritation of the episclera of our eyes. Episclera is a thin layer of tissue present between the conjunctiva and sclera. There are mainly four causes of episcleritis: an allergic response, autoimmune, vascular disease, or infections. The symptoms are redness, erythema, discomfort in the eyes, and clear discharge. It can sometimes be painful as well. In this case presentation, we will discuss the role of vitamin c in the prevention and reoccurrence of autoimmune episcleritis.
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Affiliation(s)
- Lokesh Goyal
- Hospital Medicine, Christus Spohn, Corpus Christi, USA
| | - Kunal Ajmera
- Hospital Medicine, Calvert Health Medical Center, Prince Frederick, USA
| | - Ramesh Pandit
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
- Hospital Medicine, Crozer Chester Medical Center, Upland, USA
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Mehra D, Mangwani-Mordani S, Acuna K, C Hwang J, R Felix E, Galor A. Long-Term Trigeminal Nerve Stimulation as a Treatment for Ocular Pain. Neuromodulation 2021; 24:1107-1114. [PMID: 33945660 DOI: 10.1111/ner.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ocular pain symptoms (e.g., hypersensitivity to light and wind, "burning" sensations) can be debilitating and difficult to treat. Neuromodulatory therapies targeting sensory trigeminal and central pain pathways may help treat chronic ocular pain refractory to traditional therapies. The current study evaluates the long-term effects of a trigeminal neurostimulator (TNS) on ocular pain. MATERIALS AND METHODS Retrospective review of 18 individuals at the Miami Veterans Affairs Eye Clinic with chronic, severe ocular pain who were prescribed and used TNS at home for ≥3 months. The primary outcome measures were 1) ocular symptom intensity over a 24-hour recall period (dryness, pain, light sensitivity, wind sensitivity, burning; rated on 0-10 scales) captured pre-TNS and at monthly follow-up intervals and 2) side effects. The frequency and duration of TNS was a secondary outcome measure. RESULTS The mean age of the population (n = 18) was 57.5 years (range, 34-85 years) with a male majority (67%). Two individuals discontinued use due to lack of efficacy and one due to confounding health issues. Initial mean weekly frequency of TNS use was 3.7 ± 1.9 sessions of 25.8 min at month 1 and 2.7 ± 2.3 sessions of 28.0 min at month 6. At six months, pain intensity (↓ 31.4%), light sensitivity (↓ 36.3%), wind sensitivity (↓ 32.6%), and burning sensation (↓ 53.9%) were all decreased compared to baseline (p < 0.01 for all); greater decreases in ocular pain were noted in individuals with migraine (n = 10) than those without migraine (n = 8). No significant change was noted in mean dryness scores. Fifteen subjects experienced sedation with TNS use, persisting throughout the follow-up visits. No other adverse effects were communicated by any subjects. CONCLUSION Our study suggests TNS is a safe, adjunctive treatment option in individuals with severe, chronic ocular pain. Individuals demonstrated gradual, continual improvement in pain symptoms over time within a multimodal approach.
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Affiliation(s)
- Divy Mehra
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | | | - Kelly Acuna
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA
| | - Jodi C Hwang
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth R Felix
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Physical Medicine and Rehabilitation, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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15
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Yoshikawa Y, Yokoi N, Kato H, Sakai R, Komuro A, Sonomura Y, Ikeda T, Sotozono C. Evaluation of Eye-Pain Severity between Dry-Eye Subtypes. Diagnostics (Basel) 2021; 11:166. [PMID: 33503963 DOI: 10.3390/diagnostics11020166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to assess eye pain between dry eye (DE) subtypes using questionnaires and the PainVision® (Osachi) apparatus. This study involved 52 eyes of 52 DE patients with eye pain (43 females and 9 males; mean age: 64.2 ± 13.2 (mean ± SD) years) who were classified into three DE subtypes (aqueous deficient DE (ADDE); decreased wettability DE (DWDE); and increased evaporation DE (IEDE)) based on fluorescein breakup pattern. In all subjects, severity of eye pain was evaluated using PainVision®, the DE-symptom-questionnaire visual analog scale (DSQ-VAS), and the Short-Form McGill Pain Questionnaire 2 (SF-MPQ-2). The severity of eye pain was compared between the three DE subtypes. PainVision® findings revealed greater severity of eye pain in ADDE and DWDE than in IEDE (p < 0.05, respectively), despite no difference being found in each questionnaire. A significant correlation was found between eye pain in DSQ-VAS and continuous pain, intermittent pain, neuropathic pain, and total pain in SF-MPQ-2 (R = 0.50, 0.49, 0.47, and 0.56, respectively) (all: p < 0.001). Greater severity of eye pain was found in ADDE and DWDE than in IEDE, and PainVision® was found useful for the objective assessment of eye pain.
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16
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Zhou Z, Zhu PW, Shi WQ, Min YL, Lin Q, Ge QM, Li B, Yuan Q, Shao Y. Resting-State Functional MRI Study Demonstrates That the Density of Functional Connectivity Density Mapping Changes in Patients with Acute Eye Pain. J Pain Res 2020; 13:2103-2112. [PMID: 32982384 PMCID: PMC7492714 DOI: 10.2147/jpr.s224687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/13/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose Brain function in patients with acute eye pain (EP) has not been extensively studied. An understanding of the alterations in short-range functional connectivity density (shortFCD) and long-range functional connectivity density (longFCD) in patients with EP remains elusive. The aim of the present study was to compare the functional connectivity density (FCD) between patients with EP and healthy controls (HCs) using resting-state functional connectivity. Methods A total of 40 patients with EP (26 males and 14 females) and 40 HCs (26 males and 14 females) of similar age underwent functional magnetic resonance (MR) examination at the resting state. The shortFCD and longFCD values were compared using the one-sample t-test. The differences between patients with EP and the HCs were evaluated using receiver operating characteristic (ROC) curves. Results In the patients with EP, significantly reduced shortFCD values were observed in the left posterior lobe of the cerebellum, right inferior parietal lobule, and left anterior lobe of the cerebellum, and significantly reduced longFCD values were observed in both the left and right posterior lobe of the cerebellum. Significantly increased shortFCD values were also observed in both superior frontal gyri (Brodmann area 6), and increased longFCD values were observed in the left inferior temporal gyrus and left superior frontal gyri (Brodmann area 11). Compared with the HCs, less reduction was noted among the shortFCD values of patients with EP in the right posterior lobe of the cerebellum, right supramarginal gyrus, left middle temporal gyrus, bilateral superior frontal gyri, and bilateral caudate nuclei. Conclusion EP patients shown variation of binarized shortFCD and long FCD in brain areas including premotor cortex, ventral cortical visual system, newest part of the cerebellum, cerebellum control unconscious proprioception, inhibition of involuntary movement, somatosensory association cortex, nucleus involving reward system and ventral cortical visual system which might provide an explanation of brain functional compensation for chronic eye pain and visual impairment in the EP patients.
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Affiliation(s)
- Zhou Zhou
- Institute of Pathogenic Biology, Medical College, University of South China, Hengyang 421001, Hunan, People's Republic of China.,Hunan Provincial Key Laboratory for Special Pathogens Prevention and Control, Hengyang 421001, Hunan, People's Republic of China.,Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - You-Lan Min
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Qi Lin
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, People's Republic of China
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17
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Sadig RR, Wakefield D, Fraser CL. The First Case Report of Schnitzler Syndrome Presenting with Eye Pain. Ocul Immunol Inflamm 2019; 28:175-177. [PMID: 30794479 DOI: 10.1080/09273948.2018.1563704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Schnitzler syndrome is a rare, auto inflammatory condition known to manifest with bone pain, urticarial rash, fevers, relapsing arthralgia, and fatigue. In this case report, we describe a patient who was diagnosed with Schnitzler Syndrome that had initially presented with a unilateral pressure-type headache with a sensation of a 'dagger' stabbing into the back of the eye. He also had an associated ipsilateral redness of the conjunctiva, eyelid swelling, subtle optic disc elevations bilaterally and facial flushing - but with no visual acuity, pupillary, or lacrimatory changes. Anterior segment, fundoscopy, intraocular pressures and extraocular muscle movements were otherwise normal.
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Affiliation(s)
- Richard R Sadig
- St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, Australia
| | - D Wakefield
- Faculty of Medicine, University of New South Wales, NSW Health Pathology, Sutherland Centre of Immunology, The Sutherland Hospital, The Kingsway, Caringbah, NSW, Australia
| | - C L Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
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18
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Lan DY, Zhu PW, He Y, Xu QH, Su T, Li B, Shi WQ, Lin Q, Yang YC, Yuan Q, Fang JW, Li QH, Shao Y. Gray Matter Volume Changes in Patients With Acute Eye Pain: A Voxel-Based Morphometry Study. Transl Vis Sci Technol 2019; 8:1. [PMID: 30627476 PMCID: PMC6322711 DOI: 10.1167/tvst.8.1.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose The present study was attempted to compare the differences in gray matter volume (GMV) between the acute eye pain (EP) patients and the healthy controls (HCs) using voxel-based morphometry (VBM), and to explore the relationship with clinical features and behavioral performance. Methods A total of 24 patients (17 males, 7 females) with acute EP and 24 (17 males, 7 females) age-, sex-, and education-matched HCs were recruited from the Ophthalmology Department of the First Affiliated Hospital of Nanchang University. Functional magnetic resonance imaging (fMRI) scans were conducted in all subjects. We analyzed the original three-dimensional (3D) T1 brain images by VBM and compared the GMV values with the HCs. The acute EP patients can be distinguished from the HCs by receiver operating characteristic (ROC) curve. Results Compared with HCs, the acute EP patients had significantly lower GMV values in the brain regions of the left cerebellum posterior lobe, the left limbic lobe, the right insula, the left insula, the left thalamus, the left caudate, and the right cuneus. In addition, the WMV values of the whole brain in acute EP patients decreased slightly. Conclusions These results demonstrated that the acute EP patients showed an abnormal reduction in GMV in some brain regions, which might provide valuable information for further exploration of underlying neural mechanisms. These abnormal brain regions may reflect the functional disorders of acute EP patients in somatosensory, motor, cognitive functions, and so on. Translational Relevance The VBM study provides a diagnostic method for identifying the cause of acute EP, additionally, a novel direction was presented for further exploration of underlying neural mechanisms of acute EP.
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Affiliation(s)
- Dong-Yi Lan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Ying He
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Qian-Hui Xu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Ting Su
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China.,Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian Province, China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Qi Lin
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Yan-Chang Yang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Jian-Wen Fang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Qing-Hai Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute, Nanchang, Jiangxi, China
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19
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Pan ZM, Li HJ, Bao J, Jiang N, Yuan Q, Freeberg S, Zhu PW, Ye L, Ma MY, Huang X, Shao Y. Altered intrinsic brain activities in patients with acute eye pain using amplitude of low-frequency fluctuation: a resting-state fMRI study. Neuropsychiatr Dis Treat 2018; 14:251-257. [PMID: 29386898 PMCID: PMC5767092 DOI: 10.2147/ndt.s150051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Many previous studies have reported that pain symptoms can lead to significant brain function and anatomical changes, whereas the intrinsic brain activity changes in acute eye pain (EP) patients remain unknown. Using the amplitude of low-frequency fluctuation (ALFF) method, this study aimed to evaluate the spontaneous brain activity alterations and their relationships with clinical features in acute EP patients. PARTICIPANTS AND METHODS A total of 20 patients with EP (15 males and 5 females) and 20 healthy controls (HCs; 15 males and 5 females) closely matched in age, sex, and education underwent resting-state functional magnetic resonance imaging scans. The ALFF method was applied to assess spontaneous brain activity changes. The ALFF values of the EP patients were distinguished from those of the HCs using a receiver operating characteristic curve. Pearson's correlation analysis was used to investigate the relationships between the mean ALFF signal values from many brain regions and the clinical features in EP patients. RESULTS Compared with the HCs, acute EP patients had significantly lower ALFF in the left and right precentral/postcentral gyrus and left precuneus. In contrast, acute EP patients showed higher ALFF values in the right and left parahippocampal gyri and left caudate. However, no relationship was observed between the mean ALFF signal values from the different areas and clinical manifestations in the acute EP patients. CONCLUSION We demonstrated that acute EP patients showed abnormal intrinsic brain activities in the precentral/postcentral gyrus and limbic system, which might provide useful information for explaining neural mechanisms in EP patients.
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Affiliation(s)
- Zhi-Ming Pan
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Hai-Jun Li
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jing Bao
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Nan Jiang
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qing Yuan
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Shelby Freeberg
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
| | - Pei-Wen Zhu
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lei Ye
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Ming-Yang Ma
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xin Huang
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology and Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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20
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Ferrara AN, Luck JB, Chappell MC. Twostriped Walkingstick Targets Human Eye With Chemical Defense Spray. Wilderness Environ Med 2016; 27:259-61. [PMID: 26961847 DOI: 10.1016/j.wem.2015.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/30/2015] [Accepted: 12/16/2015] [Indexed: 11/29/2022]
Abstract
Stick insects are commonly known for their fascinating and functional shape, which allows them to blend with their surroundings. However, many may not be aware of another, more threatening protective feature, a toxic spray. Anisomorpha buprestoides, one of two stick insect types in the United States to use this defense, targets the eyes and can cause ocular injury, with cases ranging from conjunctivitis to corneal ulceration. We present the case of an older woman exposed to the walkingstick's painful venom while in her home. The patient presented to an Orlando emergency department with conjunctival injection and tearing that improved with water irrigation.
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Affiliation(s)
- Ashley N Ferrara
- Emergency Department, Orlando Regional Medical Center, Orlando, FL (Dr Ferrara).
| | - John B Luck
- Emergency Department, University of California San Francisco-Fresno, Fresno, CA (Dr Luck)
| | - Mark C Chappell
- Emergency Department, Mease Dunedin Hospital, Dunedin, FL (Dr Chappell)
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21
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Kovács I, Luna C, Quirce S, Mizerska K, Callejo G, Riestra A, Fernández-Sánchez L, Meseguer VM, Cuenca N, Merayo-Lloves J, Acosta MC, Gasull X, Belmonte C, Gallar J. Abnormal activity of corneal cold thermoreceptors underlies the unpleasant sensations in dry eye disease. Pain 2016; 157:399-417. [PMID: 26675826 PMCID: PMC4733818 DOI: 10.1097/j.pain.0000000000000455] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
Dry eye disease (DED) affects >10% of the population worldwide, and it provokes an unpleasant sensation of ocular dryness, whose underlying neural mechanisms remain unknown. Removal of the main lachrymal gland in guinea pigs caused long-term reduction of basal tearing accompanied by changes in the architecture and density of subbasal corneal nerves and epithelial terminals. After 4 weeks, ongoing impulse activity and responses to cooling of corneal cold thermoreceptor endings were enhanced. Menthol (200 μM) first excited and then inactivated this augmented spontaneous and cold-evoked activity. Comparatively, corneal polymodal nociceptors of tear-deficient eyes remained silent and exhibited only a mild sensitization to acidic stimulation, whereas mechanonociceptors were not affected. Dryness-induced changes in peripheral cold thermoreceptor responsiveness developed in parallel with a progressive excitability enhancement of corneal cold trigeminal ganglion neurons, primarily due to an increase of sodium currents and a decrease of potassium currents. In corneal polymodal nociceptor neurons, sodium currents were enhanced whereas potassium currents remain unaltered. In healthy humans, exposure of the eye surface to menthol vapors or to cold air currents evoked unpleasant sensations accompanied by increased blinking frequency that we attributed to cold thermoreceptor stimulation. Notably, stimulation with menthol reduced the ongoing background discomfort of patients with DED, conceivably due to use-dependent inactivation of cold thermoreceptors. Together, these data indicate that cold thermoreceptors contribute importantly to the detection and signaling of ocular surface wetness, and develop under chronic eye dryness conditions an injury-evoked neuropathic firing that seems to underlie the unpleasant sensations experienced by patients with DED.
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Affiliation(s)
- Illés Kovács
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Carolina Luna
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
| | - Susana Quirce
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
| | - Kamila Mizerska
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
| | - Gerard Callejo
- Laboratory of Neurophysiology, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ana Riestra
- Instituto Universitario Fernández-Vega, Universidad de Oviedo and Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Laura Fernández-Sánchez
- Departamento de Fisiología, Genética y Microbiología, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Victor M. Meseguer
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
| | - Nicolás Cuenca
- Departamento de Fisiología, Genética y Microbiología, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Universidad de Oviedo and Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - M. Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
| | - Xavier Gasull
- Laboratory of Neurophysiology, Department of Biomedicine, School of Medicine, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlos Belmonte
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
- Instituto Universitario Fernández-Vega, Universidad de Oviedo and Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernández–CSIC, San Juan de Alicante, Spain
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Abstract
Pain involving the eye has numerous etiologies and is a feared challenge of many clinicians. Between a fear of the patient losing vision and a lack of familiarity with the ophthalmic equipment necessary to diagnose the problem, working up eye pain can be a daunting task. While the ophthalmologist can be indispensable in challenging cases of eye pain, this article will help clarify the unique clinical features of each etiology that can help clinicians narrow down the differential and arrive at a diagnosis.
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Affiliation(s)
- Corey W Waldman
- Sinai Hospital, Krieger Eye Institute, Baltimore, MD 21215, USA
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23
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Abstract
Purpose To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). Methods and materials This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.
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Affiliation(s)
- Ozlem Balci
- Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey
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24
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Abstract
A 38-year-old woman presented with chronic left retro-orbital pain and photophobia. Palpation of the left occipital prominence revealed tenderness in the area of the greater occipital nerve and reproduced the eye pain. The diagnosis of cervicogenic headache was confirmed by symptom resolution following left greater occipital nerve blockade. The functional association between the greater occipital nerve and the trigeminal nerve provides a potential mechanism for this case of cervicogenic eye pain.
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Affiliation(s)
- Karen R Armbrust
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
| | | | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; Department of Neurology, University of Minnesota, Minneapolis, Minnesota; Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota.
| | - Deborah I Friedman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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25
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SenthilKumaran S, Balamurgan N, Arthanari K, Thirumalaikolundusubramanian P. Periorbital swelling in emergency room: Get your eyes in. J Emerg Trauma Shock 2009; 2:209-10. [PMID: 20009315 PMCID: PMC2776373 DOI: 10.4103/0974-2700.55349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 03/25/2009] [Indexed: 11/21/2022] Open
Abstract
Facial swelling and eye pain are very common patient complaints in Emergency Departments. Clinical evidence and investigations play a crucial role in making the correct diagnosis which impacts the final disposition and management of the patient. We present a case of a patient who presented with facial swelling and headache.
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Affiliation(s)
- S SenthilKumaran
- Department of Accident, Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research Institute, Salem, India
| | - N Balamurgan
- Department of Accident, Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research Institute, Salem, India
| | - K Arthanari
- Department of Accident, Emergency and Critical Care Medicine, Sri Gokulam Hospital and Research Institute, Salem, India
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