Visualization of microneuromas by using in vivo confocal microscopy: An objective biomarker for the diagnosis of neuropathic corneal pain?

Moein, Hamid Reza; Akhlaq, Anam; Dieckmann, G; Abbouda, Alessandro; Pondelis, Nicholas; Salem, Zeina; Müller, Rodrigo; Cruzat, Andrea; Cavalcanti, Bernardo M.; Jamali, Arsia; Hamrah, Pedram

doi:10.1016/j.jtos.2020.07.004

Cited by 45 publications

(61 citation statements)

References 27 publications

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“…Specifically, one retrospective study found that in individuals with clinical suspected neuropathic pain, nerves in the subbasal layer abruptly terminated with hyperreflective enlargements. 93 This finding was termed microneuroma based on similar findings in animal models. 94 Microneuromas were observed in all subjects with ocular pain (n=30), but were not present in any subjects without pain (n=30).…”

Section: Practical Implications For Diagnosing Dry Eye and Migrainementioning

confidence: 87%

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Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Baksh¹,

Garcia²

2021

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Section: Practical Implications For Diagnosing Dry Eye and Migrainementioning

confidence: 87%

“… 94 Microneuromas were observed in all subjects with ocular pain (n=30), but were not present in any subjects without pain (n=30). 93 Other studies, however, failed to replicate these findings in other dry eye populations. 95…”

Section: Practical Implications For Diagnosing Dry Eye and Migrainementioning

confidence: 99%

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Baksh¹,

Garcia²

2021

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“…These functional changes are the consequence of altered expressions of ion channel proteins in the soma and in regenerating nerve terminals. Neuroma structures have emerged as other important morphological changes in corneal nerves and have been suggested as clinical imagining biomarkers (hallmark) of corneal neuropathic pain (Aggarwal et al, 2019 ; Bayraktutar et al, 2020 ; Moein et al, 2020 ). Taken together, these studies suggest that a corneal neuroma may represent an important pathological feature of peripheral nerve abnormalities in patients with ocular pain.…”

Section: Clinical Evidence Of Corneal Nerve Abnormalities and Dysfuncmentioning

confidence: 99%

Morphological and Functional Changes of Corneal Nerves and Their Contribution to Peripheral and Central Sensory Abnormalities

Guerrero-Moreno

Baudouin

Mélik-Parsadaniantz

et al. 2020

Front. Cell. Neurosci.

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The cornea is the most densely innervated and sensitive tissue in the body. The cornea is exclusively innervated by C- and A-delta fibers, including mechano-nociceptors that are triggered by noxious mechanical stimulation, polymodal nociceptors that are excited by mechanical, chemical, and thermal stimuli, and cold thermoreceptors that are activated by cooling. Noxious stimulations activate corneal nociceptors whose cell bodies are located in the trigeminal ganglion (TG) and project central axons to the trigeminal brainstem sensory complex. Ocular pain, in particular, that driven by corneal nerves, is considered to be a core symptom of inflammatory and traumatic disorders of the ocular surface. Ocular surface injury affecting corneal nerves and leading to inflammatory responses can occur under multiple pathological conditions, such as chemical burn, persistent dry eye, and corneal neuropathic pain as well as after some ophthalmological surgical interventions such as photorefractive surgery. This review depicts the morphological and functional changes of corneal nerve terminals following corneal damage and dry eye disease (DED), both ocular surface conditions leading to sensory abnormalities. In addition, the recent fundamental and clinical findings of the importance of peripheral and central neuroimmune interactions in the development of corneal hypersensitivity are discussed. Next, the cellular and molecular changes of corneal neurons in the TG and central structures that are driven by corneal nerve abnormalities are presented. A better understanding of the corneal nerve abnormalities as well as neuroimmune interactions may contribute to the identification of a novel therapeutic targets for alleviating corneal pain.

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“…Binotti and co-authors reported that corneal nerve sub-plexus alterations can be evaluated according to total, trunk and branch nerve density and length, tortuosity, beading, nerve reflectivity, thickness and microneuromas [ 52 ]. Moein and co-authors suggested that microneuromas may serve as a sensitive and specific biomarker for the diagnosis of neuropathic corneal pain [ 71 ]. Patients with continuous severe ocular pain for more than a year, with minimal or no ocular surface signs and who were non-responsive to topical lubricants, steroids and cyclosporine were examined using in vivo confocal microscopy by Ross and coauthors [ 72 ].…”

Section: Main Textmentioning

confidence: 99%

Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis?

McMonnies

2021

Eye and Vis

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Symptoms of dryness discomfort in soft contact lens wearers frequently lead to discontinuation from wear. The negative influence of pre-fitting tear dysfunctions appears likely to be exacerbated by the challenges to tear homeostasis caused by contact lenses. The corneal mechanisms for symptoms in contact lens wearers are different to those for dry eye disease because the cornea is insulated by the lens from ambient conditions as well as from lid wiper friction during blinking. Symptoms of dryness discomfort might be the consequence of increased lid wiper friction during blinking when the lens front surface becomes soiled and dry and exhibits very rapid tear break up. It is possible that some cases of contact lens intolerance and discontinuation could be a function of lid wiper neuropathy. In relation to the possibility of corneal neuropathy, a stagnant post-lens tear pool with the possibility of increased concentrations of metabolic by-products, cellular debris, and bacterial exotoxins, might have the potential to disturb the corneal epithelial and sub-basal nerves. Contributions by contact lens-induced inflammation to any neuropathic changes may partly depend on the degree to which inflammatory mediators are concentrated in a stagnant post-lens tear pool. It does not appear to be known if corneal neuropathic changes could develop under these conditions. The chances of neuropathic involvement may be greater if discomfort develops after a significant period of successful wear and there is a history of comorbid pain conditions. Esthesiometry and in vivo confocal microscopy in discontinued contact lens wearers may support a diagnosis of contact lens-related corneal neuralgia.

show abstract

Visualization of microneuromas by using in vivo confocal microscopy: An objective biomarker for the diagnosis of neuropathic corneal pain?

Cited by 45 publications

References 27 publications

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

Morphological and Functional Changes of Corneal Nerves and Their Contribution to Peripheral and Central Sensory Abnormalities

Could contact lens dryness discomfort symptoms sometimes have a neuropathic basis?

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