Both ocular and systemic (non-ocular) pain complaints are associated with a differential subjective response to artificial tears.

Purpose To compare dry eye (DE) symptoms and signs in subjects who tested positive versus those who tested negative for ocular surface matrix metalloproteinase 9 (MMP-9) using the InflammaDry point of care test (RPS, Sarasota, FL). Methods In this cross-sectional study, individuals seen in the Miami Veterans Affairs eye clinic with DE symptoms, as evidenced by DE questionnaire 5 (DEQ5) ≥6, were given standardized questionnaires to assess DE symptoms and ocular and non-ocular pain complaints. Also, a complete evaluation was conducted to measure ocular surface signs of DE. MMP-9 testing was performed using the InflammaDry once in each eye, per the manufacturer’s instructions. The main outcome measure was a comparison of DE symptoms and signs in MMP-9 positive versus negative subjects. Results Of 128 subjects, 50 (39%) were positive for MMP-9 for InflammaDry testing in either eye. No statistically significant differences in mental health indices, DE symptoms, or ocular surface signs were seen in subjects based on MMP-9 status. Conclusion In our population, there was no difference in the DE profile by both symptoms and signs between those testing positive versus negative for MMP-9 on the ocular surface. This suggests that clinical exam alone cannot predict patients with clinically significant inflammation.

Purpose Conjunctival microvascular responses may be a surrogate metric of efferent neural pathway function innervating the ocular surface as changes in blood flow occur within seconds after a stimulus. As somatosensory dysfunction may partially underlie dry eye (DE), in this study we evaluate whether bulbar conjunctival microvascular alterations correlate with various aspects of DE. Methods Fifty-six DE patients were prospectively recruited from a Veterans Affairs ophthalmology clinic over an 11-month period. DE symptoms and ocular pain were assessed along with DE signs. A novel functional slit lamp biomicroscope (FSLB) was used to image the temporal bulbar conjunctiva from the right eye before and after central corneal stimulation with an air puff. Blood flow velocities were measured and noninvasive microvascular perfusion maps (nMPMs) were created. Results The bulbar blood flow velocity was 0.50±0.15 mm/s at baseline and increased to 0.55±0.17 mm/s after stimulation (P<0.001); the average change in velocity was 0.05±0.09. nMPMs values and venule diameter, on the other hand, did not significantly increase after stimulation (1.64±0.004 at baseline, 1.65±0.04 after stimulation, P=0.22 and 22.13±1.84 m at baseline, 22.21±2.04 μm after stimulation, P=0.73, respectively). Baseline blood flow velocity positively associated with Schirmer scores (r=0.40, P=0.002). Those with higher self-rated wind hyperalgesia demonstrated less change in blood flow velocity (r= −0.268, P=0.046) after air stimulation on the central cornea. Conclusion Conjunctival blood flow velocity, but not vessel diameter or complexity, increases after wind stimuli. Baseline flow positively correlated with Schirmer scores while change in flow negatively correlated with self-reported wind hyperalgesia.