Ocular Microbiology and Immunology Group
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2016 OMIG Abstract 19

In Vivo Confocal Microscopy Demonstrates Diagnostic Utility in the Differentiation of Patients with Corneal Neuropathic Pain from Dry Eye Disease
Hamid-Reza Moein, Gabriela Dieckmann, Alessandro Abbouda, Nicholas Pondelis, Arsia Jamali,
Zeina Salem, Pedram Hamrah
Boston Image Reading Center and Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

Purpose: The diagnosis of corneal neuropathic pain (CNP) is challenging and most often difficult to differentiate from dry eye disease (DED). In addition to pain, CNP can present with similar signs and symptoms of DED. Thus objective diagnostic tools to identify patients with CNP are needed. The purpose of this study is to compare subbasal corneal nerve and immune dendritiform cell alterations between patients with DED and CNP.

Methods: This cross-sectional study included patients with DED (n=14), CNP (n=15), and age and sex-matched normal controls (n=16), who underwent central corneal laser in vivo confocal microscopy (IVCM, HRT3/RCM). Subbasal corneal nerve density, presence of micro-neuromas, and dendritiform cell density (DCD) were assessed and compared between the groups by 2 masked observers.

Results: Total nerve density decreased in DED (13.63±1.56 mm/mm²) and CNP patients (11.64±1.90 mm/mm²) as compared to normal controls (23.90±0.92 mm/mm²; p <0.001). While total nerve density was lower in patients with CNP as compared with DED, it was not statistically significant (p=0.42). Interestingly, micro-neuromas were observed in all patients with CNP, while they were not detected in any of the patients with DED (sensitivity and specificity of 100%). DCD was increased in both DED (82.29±18.28 cells/mm²) and CNP (73.12±29.91 cells/mm²) as compared to normal controls (24.81±4.48 cells/mm²; p=0.10). There was no significant difference in DCD between DED and CNP patients (p=0.79).

Conclusions: IVCM may be used as an adjunct diagnostic tool to differentiate CNP from DED. Micro-neuromas might serve as a sensitive and specific criterion in differentiating patients with CNP from DED.

Funding support: NIH R01-EY022695 (PH), Research to Prevent Blindness Career Development Award (PH), Massachusetts Lions Eye Foundation.
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2016 Agenda and Abstracts | < Previous | Next >