Fibromyalgia Associated With Corneal Sensitivity, Ocular Pain

By Lorraine L. Janeczko

February 08, 2018

NEW YORK (Reuters Health) - Patients with fibromyalgia have increased eye sensitivity and pain, researchers from Turkey report.

“Patients with fibromyalgia have increased corneal sensitivity,” note Dr. V. Aykut of Istanbul Medeniyet University School of Medicine and colleagues in Eye, online January 26. The reported symptoms are “similar to dry eye disease in the absence of it," they explain.

The team conducted a detailed ophthalmological examination, measured the tear film breakup time (TBUT), and performed a Schirmer I test without anesthetic (SIT) on 30 female and six male patients with fibromyalgia (mean age, 47). They also examined 33 healthy women and six healthy men as controls. Both groups included only patients with no eye disease.

The patients and controls were matched at baseline for age, sex and visual acuity, and both groups had similar SIT (16.1 mm vs. 15.3 mm, respectively) and TBUT results (17.8 vs. 18.9 seconds).

The authors quantified the participants' subjective complaints using ocular surface disease index (OSDI) scores, and they determined corneal sensation using Cochet-Bonnet esthesiometry.

In the patients, corneal sensation was significantly higher than in controls in central (60.0 vs. 55.0 mm), superior (57.5 vs. 50.0 mm), and inferior (53.89 vs. 46.03 mm) regions. Mean OSDI score also was significantly higher (19.89 vs. 6.13 in controls).

Dr. Winston D. Chamberlain, an associate professor of ophthalmology at Oregon Health & Science University in Portland, told Reuters Health by email, "The results of this study are not surprising. Fibromyalgia is a chronic pain disorder that likely stems from lower- and higher-order neuron disorders that can affect any part of the body, including the eyes.”

“'Neuropathic' pain can be found in the eyes of many 'dry-eye' patients who present to ophthalmology and cornea clinics,” he added. “This could be explained by dysregulation of nerve firing leading to inappropriate perception of various benign stimuli."

"The study and others like it remind the ophthalmologist that the origins of ocular surface pain cannot all be attributed to dry-eye disease," said Dr. Chamberlain, who was not involved in the study. "Tear film dysfunction, while a major player in contributing to many forms of ocular surface discomfort, does not explain all disease mechanisms. The treatment modalities for neuron disorders like those underlying fibromyalgia are quite different from the treatments for tear film deficiency/dysfunction, and to treat appropriately, the ophthalmologist needs to be able to recognize the source of the symptoms."

"The thoughtful approach to ocular surface pain involves the recognition of corneal nerve sensitivity, something that is not measured in a routine ophthalmic exam," he advised. "If ophthalmologists ignore this component of disease, the traditional dry-eye therapies, such as over-the-counter lubricants and prescription eye drops and ointments, will not be therapeutic."

Dr. Chamberlain noted several weaknesses in the study, including the clinician not being masked to the results, and the high variability and poor repeatability of Cochet-Bonnet esthesiometry.

"We need better methods to objectively measure and correlate peripheral and central neuron activity with patient symptoms," he added.

"Many ophthalmologists are not comfortable prescribing the oral medication frequently used by pain specialist to treat peripheral and central sensitization syndromes," he explained. "These medications include gabapentin and lamotrigine, which have been used historically to treat epilepsy. They can have complex systemic side effects that require monitoring."

"A team approach between ophthalmologists and neurologists or pain specialists may increase patient success," Dr. Chamberlain recommended.

Dr. Aykut did not respond to requests for comment.


Eye 2018.