title: Incomplete response to artificial tears is associated with features of neuropathic ocular pain.
abstract: Artificial tears are first-line therapy for patients with dry eye symptoms. It is not known, however, which patient factors associate with a positive response to therapy. The purpose of this study was to evaluate whether certain ocular and systemic findings are associated with a differential subjective response to artificial tears.
  
  
  
  Cross-sectional study of 118 individuals reporting artificial tears use (hypromellose 0.4%) to treat dry eye-associated ocular pain. An evaluation was performed to assess dry eye symptoms (via the dry eye questionnaire 5 and ocular surface disease index), ocular and systemic (non-ocular) pain complaints and ocular signs (tear osmolarity, tear breakup time, corneal staining, Schirmer testing with anaesthesia, and eyelid and meibomian gland assessment). The main outcome measures were factors associated with differential subjective response to artificial tears.
  
  
  
  By self-report, 23 patients reported no improvement, 73 partial improvement and 22 complete improvement in ocular pain with artificial tears. Patients who reported no or partial improvement in pain with artificial tears reported higher levels of hot-burning ocular pain and sensitivity to wind compared with those with complete improvement. Patients were also asked to rate the intensity of systemic pain elsewhere in the body (other than the eye). Patients who reported no or incomplete improvement with artificial tears had higher systemic pain scores compared with those with complete improvement.
  
  
  
  Both ocular and systemic (non-ocular) pain complaints are associated with a differential subjective response to artificial tears.
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: Hatim
authors.initials: H
authors.lastname: Batawi
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Felix
authors.affiliation: Departement of Ophthalmology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Todd P
authors.initials: TP
authors.lastname: Margolis
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Sarantopoulos
authors.affiliation: John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Eden R
authors.initials: ER
authors.lastname: Martin
authors.affiliation: Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, Florida, USA John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Levitt
mesh_terms: D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D058447:Eye Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D065347:Hypromellose Derivatives / Q000008:administration & dosage; D065346:Lubricant Eye Drops / Q000008:administration & dosage*; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D065346:Lubricant Eye Drops; D065347:Hypromellose Derivatives
keywords: Epidemiology; Ocular surface; Treatment Medical