Altered Pain Perception May Underlie Some Dry Eye Disease

Lara C. Pullen, PhD

September 04, 2014

Approximately 1 in 10 women in the United Kingdom have dry eye disease (DED), with prevalence increasing with age. An investigation of possible risk factors for DED has found that the strongest associations were between chronic pain syndromes such as pelvic pain, irritable bowel syndrome, and fibromyalgia and DED. Depression was also strongly associated with the presence of DED.

Jelle Vehof, PhD, from the Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, United Kingdom, and the Department of Ophthalmology and Epidemiology, University Medical Center Groningen, The Netherlands, and colleagues published the results of their cross-sectional association study online September 3 in the British Journal of Ophthalmology. They used a questionnaire to collect patient-provided information on DED and risk factors from 3824 female twins from 2410 families. Theirs is the first population-based study of DED in the United Kingdom.

Of the women surveyed, 9.6% had been diagnosed with DED and used artificial tears, and 20.8% reported DED symptoms in the past 3 months.

The study confirmed many of the previously described risk factors for DED, including immune-mediated diseases such as rheumatoid arthritis, thyroid diseases, and allergies. Atopic disorders such as asthma and eczema were also associated with DED.

Unsurprisingly, the questionnaires revealed that women who had ophthalmic surgery were more likely to be diagnosed with DED, perhaps because they were under the care of an ophthalmologist.

"We have found a strong significant association between DED and cataract surgery, showing a 70% higher prevalence of DED in subjects who had undergone cataract surgery. DED after ophthalmic surgery has been described, particularly after refractive surgery. Decreased corneal sensation and changes in tear physiology after phacoemulsification have been found, as well as a significantly decreased goblet cell density after cataract surgery," the authors write.

Several of the identified risk factors for DED point toward an underlying etiology that involves a predisposition to chronic pain or somatization, leading the investigators to conclude "that DED is a very common problem among women in a population-representative cohort in the UK, becomes more prevalent with advancing age and has a significant effect on self-perceived health. Besides confirming some well-known risk factors, this study has found new associations of DED, raising the possibility that altered pain perception and psychological and somatisation factors influence DED and its symptomatology."

TwinsUK receives support from the Wellcome Trust, European Union, and the National Institute for Health Research funded BioResource, Clinical Research Facility and Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. One coauthor is a Fight for Sight Early Career Investigator Award holder. The other authors have disclosed no relevant financial relationships.

Br J Ophthalmol. Published online September 3, 2014. Full text

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