title: Burning Eye Syndrome: Do Neuropathic Pain Mechanisms Underlie Chronic Dry Eye?
abstract: OBJECTIVE
  Dry eye is a multi-factorial disorder that manifests with painful ocular symptoms and visual disturbances, which can only be partly attributed to tear dysfunction. This disorder may also involve neuroplasticity in response to neuronal injury. This review will emphasize the key characteristics of dry eye pain and its pathologic mechanisms, making the argument that a subset of dry eye represents a neuropathic pain disorder of the eye, more appropriately called "burning eye syndrome."
  
  
  METHODS
  A literature review was conducted using a PubMed search focusing on dry eye, corneal nociception, and neuropathic pain. Articles were reviewed and those discussing clinical course, pathophysiology, and neuronal regulation of chronic ocular pain as related to dry eye were summarized.
  
  
  RESULTS
  We found that there is a discordance between ocular pain and dryness on the ocular surface. Although tear dysfunction may be one of the initial insults, its persistence may be associated with repeated ocular sensory nerve injury leading to an acute-to-chronic pain transition associated with neuropathologic changes (peripheral and central sensitization), neuronal dysfunction, and spontaneous ocular pain.
  
  
  CONCLUSIONS
  Dry eye is becoming a major health concern due to its increasing incidence, significant morbidity, and economic burden. Recent evidence suggests that a subset of dry eye may be better represented as a chronic neuropathic pain disorder due to its features of dysesthesia, spontaneous pain, allodynia, and hyperalgesia. Future therapies targeted at the underlying neuroplasticity may yield improved efficacy for patients with this subset of dry eye, which we term "burning eye syndrome."
authors.affiliation: *Department of Anesthesiology, Perioperative Medicine and Pain Management Jerry.kalangara@gmail.com.
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Kalangara
authors.affiliation: Miami Veterans Affairs Medical Center, Miami, Florida, USA Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: *Department of Anesthesiology, Perioperative Medicine and Pain Management John P. Hussman Institute for Human Genomics John T. Macdonald Foundation Department of Human Genetics Miami Veterans Affairs Medical Center, Miami, Florida, USA.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Levitt
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida, USA Miami Veterans Affairs Medical Center, Miami, Florida, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Felix
authors.affiliation: *Department of Anesthesiology, Perioperative Medicine and Pain Management.
authors.forename: Ramon
authors.initials: R
authors.lastname: Alegret
authors.affiliation: *Department of Anesthesiology, Perioperative Medicine and Pain Management Miami Veterans Affairs Medical Center, Miami, Florida, USA.
authors.forename: Constantine D
authors.initials: CD
authors.lastname: Sarantopoulos
mesh_terms: D015352:Dry Eye Syndromes / Q000150:complications*; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology*; D009437:Neuralgia / Q000209:etiology*
keywords: Cornea; Dry Eye; Hyperalgesia; Neuronal Dysfunction; Neuropathic Pain; Sensitization
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