Purpose

To illustrate that ocular pain may occur in patients with neurotrophic keratopathy (NK) that typically are thought to lack symptoms of discomfort, and that aa subset of these patients may also present with neuropathic corneal pain (NCP).

Method

Retrospective Case series of 7 stage 1 NK patients who presented with concurrent ocular pain, as confirmed by clinical examination, proparacaine challenge test, and in vivo corneal confocal microscopy (IVCM). Records were assessed for results of ocular surface disease index (OSDI), pain on visual analog scale (VAS), ocular pain assessment survey (OPAS), best-corrected visual acuity (BCVA), corneal fluorescein staining (CFS) score, and IVCM findings. IVCM findings were compared to that of 20 healthy reference controls.

Results

Mean age of patients was 63.7 ± 11.6 (range 44–76) years and 56.9 ± 8.6 (range 42–74) years in reference controls (p = 0.11). At presentation, ocular discomfort was 8.0 ± 1.3 (range 7–10) on VAS and mean OSDI scores were 72.26 ± 6.81 (range 62.50–79.54). Mean BCVA was 20/40, and mean CFS scores were 3.43 ± 0.79 (range 2–4) on the Oxford scale. IVCM analysis showed significant decrease in mean total, main and branch nerve densities in ranges consistent with NK as compared to normal controls (p < 0.001 for all), increased dendritiform cell density in three patients (p < 0.001), and the presence of microneuromas in six of the patients.

Conclusion

Patients with NK are thought to present with hypoesthesia. However, nerve damage and inflammation, which play a role in the development of NK may result in the development of chronic ocular pain, such as NCP, resulting in potential underdiagnosis of either disease.

中文翻译：

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神经营养性角膜病患者并发眼痛

目的

为了说明通常被认为缺乏不适症状的神经营养性角膜病 (NK) 患者可能会出现眼痛，并且这些患者的一部分也可能出现神经性角膜疼痛 (NCP)。

方法

临床检查、丙美卡因激发试验和体内角膜共聚焦显微镜 (IVCM) 证实的 7 名 1 期 NK 患者的回顾性病例系列，这些患者同时出现眼痛。评估记录的眼表疾病指数 (OSDI)、视觉模拟量表 (VAS)、眼痛评估调查 (OPAS)、最佳矫正视力 (BCVA)、角膜荧光素染色 (CFS) 评分和 IVCM 的结果发现。将 IVCM 结果与 20 名健康参考对照的结果进行比较。

结果

在参考对照中，患者的平均年龄为 63.7 ± 11.6（范围 44-76）岁和 56.9 ± 8.6（范围 42-74）岁（p = 0.11）。就诊时，VAS 的眼部不适为 8.0 ± 1.3（范围 7-10），平均 OSDI 评分为 72.26 ± 6.81（范围 62.50-79.54）。在牛津量表上，平均 BCVA 为 20/40，平均 CFS 分数为 3.43 ± 0.79（范围 2-4）。IVCM 分析显示，与正常对照组相比，在与 NK 一致的范围内，平均总神经、主神经和分支神经密度显着降低（所有 p < 0.001），三名患者的树突状细胞密度增加（p < 0.001），并且存在微神经瘤在六名患者中。

结论

NK 患者被认为存在感觉迟钝。然而，在 NK 的发展中发挥作用的神经损伤和炎症可能导致慢性眼痛的发展，例如 NCP，从而导致对这两种疾病的潜在漏诊。