Neuropathy May Drive Dry Eye in Migraine Patients

By Anne Harding

May 16, 2019

NEW YORK (Reuters Health) - Migraine patients with dry eye (DE) are more likely to have symptoms suggestive of neuropathy than DE patients who don't have migraines, according to new findings.

The results raise the possibility that neuromodulating therapies could be helpful in patients with DE that does not respond to topical therapy, whether or not they have migraine, Dr. Anat Galor of the University of Miami's Bascom Palmer Eye Institute and Miami VA Medical Center told Reuters Health by phone.

"We need to think beyond just what we see on the surface and consider nerves," she said. "Strategies used by pain specialists to treat nerve dysfunction elsewhere can be modified and used in eye pain."

DE is highly prevalent, and migraine patients have more DE symptoms than individuals without migraines, Dr. Galor and her team note in the British Journal of Ophthalmology, online April 30.

To investigate whether patients with migraine have a unique DE symptom profile, the researchers looked at 250 patients with DE symptoms treated at the Miami VA. The cohort included 31 patients with migraine, who were older (62 vs. 57 years) and more likely to be women (26% vs. 6%) than patients without migraine.

Mean Ocular Surface Disease Index was 53.93 for migraine patients vs. 36.30 for the control group (P=0.0001), and mean Neuropathic Pain Symptom Inventory modified for the Eye scores were 39.39 and 21.86, respectively (P=0.0001).

The biggest differences between the groups were in questions addressing "feeling of burning, squeezing, pressure, stabbing, electric shocks, tingling, pins-needles and evoked pain to wind, light and contact with something cold and hot."

However, ocular surface parameters were similar for the two groups.

In her own research, Dr. Galor noted, patients with resistant migraine treated with botulinum toxin had improvements in eye pain and dryness.

Further research should look at which neuromodulating therapies are most effective in patients with an underlying nerve component to their DE symptoms, Dr. Galor said.

"We use the word 'dry eye' as a condition. That has really limited our ability to really deliver precision medicine," she added.


Br J Ophthalmol 2019.