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Coexistence of neuropathic corneal pain, corneal nerve abnormalities, depression, and low quality of life

Eye volume 38, pages 499–506 (2024)Cite this article

Subjects

Abstract

Purpose

To evaluate the quality of life (QoL), mental health conditions and corneal morphology in neuropathic corneal pain (NCP) subjects without a significant ocular surface disease.

Methods

A composite questionnaire was administered to 228 consecutive subjects, assessing the pain intensity, duration, and quality using a modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and Pain Detect (PD) questionnaires. Subjects diagnosed with possible central NCP and two sub-groups of patients diagnosed with peripheral ocular pain completed an additional battery of mental health questionnaires and were examined by In Vivo Confocal Microscopy (IVCM).

Results

Of the 76 subjects that reported chronic ocular pain (duration >1 month), 53 were classified with probable NCP. Nine subjects without signs that justify the pain and non-responding to topical anaesthesia, were considered affected by central NCP. In these patients, a significant negative correlation was found between the presence pain and the mental component of the QoL (R2 = 0.733), and a positive correlation between the severity of pain the presence post-traumatic stress disorder (R2 = 0.83) and depression (R2 = 0.93). Although neuromas and sprouting had higher frequency in the central NCP group compared the control groups, these differences was not statistically different.

Conclusions

The assessment of ocular pain characteristics using multiple questionnaires and IVCM may help to recognize differences between nociceptive and neuropathic pain. An association between pain intensity and mental health condition may guide the therapeutical choices.

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Fig. 1: Example of the facial/ocular graphical representations from 3 patients localizing her/his pain and its radiation.
Fig. 2: Abnormal findings by in vivo laser confocal microscopy (IVCM) in patients affected by central neuropathic corneal pain without evident corneal pathology.

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Data availability

Original data are stored in the hospital database along with results of the confocal microscopy findings. All scores are available upon request to the corresponding author.

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Authors and Affiliations

  1. Department of Neurosciences, Ophthalmology Unit, University of Padua, Padua, Italy

    Andrea Leonardi, Oren Mark Feuerman, Elena Salami, Daniela Lazzarini & Fabiano Cavarzeran

  2. Anesthesiology and Intensive Medicine, Department of Medicine - DIMED, University of Padua, Padua, Italy

    Ulderico Freo

  3. Department of Neurosciences, Headache Centre, University of Padua, Padua, Italy

    Ferdinando Maggioni

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Contributions

Conception and design: DL, AL, UF, FM. Analysis and interpretation: AL, OMF, UF, FC. Writing the article: AL, OMF, ES. Critical revision of the article: ES, FC, UF, FM, DL. Final approval of the article: AL, OMF, ES, FC, DL, UF, FM. Data Collection: AL, UR, ES, OMF, DL. Provision of materials, patients, or resources: AL, DL, UR. Statistical expertise: FC. Obtaining funding: AL, UF. Literature search: AL, OMF, UF, EL. Administrative, technical or logistic support: DL, FC. Statement about conformity with author information: none.

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Correspondence to Andrea Leonardi.

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Leonardi, A., Feuerman, O.M., Salami, E. et al. Coexistence of neuropathic corneal pain, corneal nerve abnormalities, depression, and low quality of life. Eye 38, 499–506 (2024). https://doi.org/10.1038/s41433-023-02710-w

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