Symptoms of dry eye and recurrent erosion syndrome after refractive surgery

Hovanesian, John; Shah, Sneha; Maloney, Robert K.

doi:10.1016/s0886-3350(00)00835-x

Cited by 194 publications

(101 citation statements)

References 21 publications

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“…However, sensations described as ''sharp pains,'' ''eyelid sticking to the eyeball,'' or ''soreness of the eyelid to touch'' occur 6 or more months after surgery in 5% to 25% of patients, while nearly 50% report feelings of ''dryness.'' 55 Corneal cold thermoreceptor fibers are implicated in the regulation of basal tearing rate and have been proposed also as the source of the unpleasant dryness sensation associated with dry eye disease. 13,20,24,26 The differences in time course and characteristics of disturbances in corneal nerve activity observed in mice after PRK confirm the important role played by aberrant impulse activity in axotomized nerves for the appearance of dysesthesias following PRK 56 and lend support to the proposal that, among the different functional subclasses of corneal nerves, cold thermoreceptors are major players in the development of phantom unpleasant dryness sensation after photorefractive surgery procedures.…”

Section: Discussionmentioning

confidence: 99%

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Bech

González-González

Artime

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To define the characteristics and time course of the morphologic and functional changes experienced by corneal sensory nerves after photorefractive keratectomy (PRK).METHODS. Unilateral corneal excimer laser photoablation was performed in 54 anesthetized 3-to 6-month-old mice; 11 naïve animals served as control. Mice were killed 0, 3, 7, 15, and 30 days after PRK. Excised eyes were placed in a recording chamber superfused at 348C. Electrical nerve impulse activity of single sensory terminals was recorded with a micropipette applied onto the corneal surface. Spontaneous and stimulus-evoked (cold, heat, mechanical, and chemical stimuli) nerve terminal impulse (NTI) activity was analyzed. Corneas were fixed and stained with anti-b-Tubulin III antibody to measure nerve density and number of epithelial nerve penetration points of regenerating subbasal leashes.RESULTS. Nerve fibers and NTI activity were absent in the injured area between 0 and 7 days after PRK, when sparse regenerating nerve sprouts appear. On day 15, subbasal nerve density reached half the control value and abnormally responding cold-sensitive terminals were recorded inside the lesion. Thirty days after PRK, nerve density was almost restored, active cold thermoreceptors were abundant, and polymodal nociceptor activity first reappeared.CONCLUSIONS. Morphologic regeneration of subbasal corneal nerves started shortly after PRK ablation and was substantially completed 30 days later. Functional recovery appears faster in cold terminals than polymodal terminals, possibly reflecting an incomplete damage of the more extensively branched cold-sensitive axon terminals. Evolution of postsurgical discomfort sensations quality may be associated with the variable regeneration pattern of each fiber type.

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Section: Discussionmentioning

confidence: 99%

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Bech

González-González

Artime

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…46 Disturbances of nerve excitability presumably persist in injured and regenerating nerve fibers of surgically treated corneas for long periods and would be the cause of the altered sensitivity and aberrant sensations experienced by some patients, weeks and even months after corneal surgery. 3,5,48 …”

Section: Discussionmentioning

confidence: 99%

“…3 Postsurgical acute pain is often followed by less-intense discomfort sensations that may persist for weeks or months after surgery. 4,5 Photorefractive surgery causes injury to the epithelial and stromal cells of the cornea and to corneal sensory nerve branches running in the lesioned tissues and causes various degrees of local inflammatory reaction. 6 -8 The cornea is innervated by sensory fibers that have their origins in different functional types of trigeminal ganglion neurons: mechanonociceptor fibers activated by mechanical forces; polymodal nociceptor fibers that respond to mechanical, thermal, and chemical noxious stimuli; and cold receptor fibers that respond primarily to temperature reductions on the corneal surface.…”

mentioning

confidence: 99%

Impulse Activity in Corneal Sensory Nerve Fibers after Photorefractive Keratectomy

Gallar

Acosta

Gutiérrez

et al. 2007

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To evaluate the changes in spontaneous and stimulusevoked nerve impulse activity of corneal polymodal and mechanonociceptor sensory fibers of the cornea after photorefractive keratectomy (PRK). METHODS.A central corneal ablation 6 mm in diameter and 70 m in depth was performed with an excimer laser in both eyes of three anesthetized cats, after removal of the corneal epithelium. Single nerve fiber activity was recorded in these animals 12 to 48 hours after surgery. Activity in corneal nerve fibers with receptive fields (RFs) within and/or close to the wound, as well as with RFs far from the lesioned area, was studied. Incidence and frequency of spontaneous discharges and nerve impulse firing responses to mechanical (Cochet-Bonet esthesiometer) and chemical (CO 2 gas pulses) stimuli were studied. RESULTS. The incidence of nociceptor fibers exhibiting ongoing activity (15/35 vs. 1/9) and the frequency of their spontaneous firing (0.25 Ϯ 0.09 impulses [imp]/s versus 0.08 Ϯ 0.08 imp/s) was higher in fibers with RFs within and/or bordering the wounded area than in those with RFs far away from the wound. Mechanical responsiveness of fibers with RFs within or nearby the ablated area was often reduced. In these fibers, CO 2 pulses evoked a lower-frequency impulse discharge (0.9 Ϯ 0.2 imp/s inside, 2.3 Ϯ 0.7 imp/s outside the wound). CO 2 -evoked discharges recorded from fibers innervating the intact wound border were similar to those recorded in corneal fibers of intact cats. CONCLUSIONS. The spontaneous impulse activity and the abnormal responsiveness shown by a part of the corneal nerve fibers innervating the injured cornea are presumably the neurophysiological substrate of the pain sensations experienced by human patients hours after PRK surgery. (Invest Ophthalmol Vis Sci. 2007;48:4033-4037) DOI:10.1167/iovs.07-0012 P hotorefractive surgery, and other procedures such as phototherapeutic keratectomy (PTK) performed with excimer laser, has become a widely used procedure for treating myopia, hypermetropia, astigmatism, scars, and other diseases of the cornea.1,2 This type of surgery-in particular photorefractive keratectomy (PRK)-is accompanied by severe ocular pain that becomes strongest 24 hours after PRK and is described as a throbbing, burning, and/or stinging pain usually accompanied by nasal congestion, tearing, and photophobia.3 Postsurgical acute pain is often followed by less-intense discomfort sensations that may persist for weeks or months after surgery. 4,5Photorefractive surgery causes injury to the epithelial and stromal cells of the cornea and to corneal sensory nerve branches running in the lesioned tissues and causes various degrees of local inflammatory reaction.6 -8 The cornea is innervated by sensory fibers that have their origins in different functional types of trigeminal ganglion neurons: mechanonociceptor fibers activated by mechanical forces; polymodal nociceptor fibers that respond to mechanical, thermal, and chemical noxious stimuli; and cold receptor fibers that respond primarily to...

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“…One week after treatment, increased NPD1 synthesis was observed in corneas treated with DHA, suggesting that PEDF increases 80% recovery ( 136 ). As a consequence, about 48% of patients reported ocular dryness, and 20% of these patients suffered recurrent epithelial erosions ( 137 ).…”

Section: -3 Fatty Acids and Their Derivatives Are Important In The Rementioning

confidence: 98%

Significance of lipid mediators in corneal injury and repair

Kenchegowda

Bazán

2010

Journal of Lipid Research

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ers of the cornea function in a synchronized way to ensure this transparency.Corneal tissue has three distinct layers, the epithelial, stroma, and endothelial layers, and two acellular regions, the Bowman's layer, which separates the epithelium from the stroma, and the Descemet's membrane, which is between the stroma and the endothelium ( Fig. 1A ). All three layers have a uniform and consistent arrangement throughout the tissue in order to precisely bend and transmit light, fi rst to the lens and then to the retina.The corneal epithelium is the most outer layer, consisting of fi ve to seven layers of stratifi ed nonkeratinized epithelia. The basal cells have a prominent nucleus, are mitotically active, and adhere to the basement membrane through an adhesion complex that anchors the epithelium to the Bowman's layer. Turnover of epithelial cells occurs every fi ve to seven days by displacement of existing cells, which begin their movement toward the surface to then form two to three layers of wing-shaped cells; the cells then begin terminal differentiation and desquamation. The outer-most layer of the epithelium is in intimate contact with the tear fi lm that keeps the surface moist and free of damage that can result from drying (dry eye). This is The cornea, known as the "window of the eye," has two major functions: to protect the intraocular structures and to refract light. In fact, the cornea accounts for two-thirds of the refractive power of the eye. The most important characteristic of this tissue is its transparency, and the lay-

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Symptoms of dry eye and recurrent erosion syndrome after refractive surgery

Cited by 194 publications

References 21 publications

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Functional and Morphologic Alterations in Mechanical, Polymodal, and Cold Sensory Nerve Fibers of the Cornea Following Photorefractive Keratectomy

Impulse Activity in Corneal Sensory Nerve Fibers after Photorefractive Keratectomy

Significance of lipid mediators in corneal injury and repair

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