Depression, Pain More Common in Dry Eye Than Tear Film Flaw

Lara C. Pullen, PhD

November 27, 2014

CHICAGO — Nonocular pain and mental health problems are more prevalent in dry eye than tear film parameters, according to research presented here at the American Academy of Ophthalmology 2014 Annual Meeting.

Investigators led by Anat Galor, MD, from the Miami Veterans Administration Medical Center, Florida, presented their prospective cross-sectional examination of dry eyes.

Her team measured tear parameters in 64 patients (mean age 66 years) and assessed their relationship with dry eye symptoms and systemic complaints, such as pain, depression, and post-traumatic stress disorder (PTSD).

Approximately 49% of dry eye scores were related to PTSD and a number of nonocular pain areas. Correlations between eye symptoms and all systemic measures were moderate (r = .52 - .65, P < .05).

"No tear parameters significantly predicted symptoms," Dr Galor reported.

Asked by Medscape Medical News to comment, Joseph Tauber, MD, from the Tauber Eye Center in Kansas City, Missouri, who presented the latest from the OPUS-2 trial, acknowledged, "We don't really know what dry eye is."

OPUS-2 is a randomized double-masked placebo-controlled study of the experimental ophthalmic solution lifitegrast conducted at 31 US sites.

Lifitegrast is a novel dry eye disease therapeutic that binds to lymphocyte functional antigen 1 on T-cells and prevents them from interacting with intercellular adhesion molecule 1. When lifitegrast is dropped into the eyes, it binds to T-cells, which circulate out of the eye and die, Dr. Tauber explained.

The company is very pleased with the results and "feels comfortable going to the FDA," he reported. The new agent did not, however, improve the tear parameter of inferior corneal staining.

Predisposed to Chronic Pain

A separate investigation of possible risk factors for dry eye published earlier this year found associations with chronic pain syndromes, such as pelvic pain, irritable bowel syndrome, and fibromyalgia. Depression was also strongly associated with dry eye.

Jelle Vehof, PhD, King's College London, United Kingdom, and colleagues confirmed many of the previously described risk factors for dry eye, including immune-mediated diseases such as rheumatoid arthritis, thyroid diseases, and allergies.

Several of the identified risk factors for dry eye point toward an underlying etiology that involves a predisposition to chronic pain or somatization. Dr Galor and her team conclude that physicians should consider systemic status when evaluating patients with dry eye.

There was no commercial funding for this study. Dr Galor is a consultant for Bausch & Lomb. Dr Tauber reports a relationship with Allergen. Dr Vehof has disclosed no relevant financial relationships.

American Academy of Ophthalmology (AAO) 2014 Annual Meeting: Abstract PO056. Presented October 19, 2014.

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