Determinants of Ocular Pain Severity in Patients With Dry Eye Disease

Purpose To quantify the severity of ocular pain in patients with dry eye disease (DED) and evaluate factors associated with pain severity. Design Cross-sectional study. Methods Eighty-four patients with DED were asked to score their severity level of ocular pain using a 10-point scale, with 10 indicating the most severe pain. All patients also had a comprehensive ophthalmic assessment including a detailed history, Ocular Surface Disease Index (OSDI) questionnaire, and ocular surface examination. Regression analysis was used to determine the factors associated with ocular pain severity. Results The mean OSDI score was 45.6 ± 23.1. At least some degree of ocular pain (score >1) was reported by 88.1% of patients, including mild pain (scores 2–4) in 46.4%, moderate pain (scores 5–7) in 34.5%, and severe pain (scores 8–10) in 7.1% of patients. Ocular pain levels significantly correlated with the OSDI score (r_s = 0.49, P <.001). Regression analysis showed that the severity of ocular pain had a significant association with use of antidepressant medications (P =.045) but not with tear breakup time, corneal fluorescein staining, or ocular medications used by patients. In patients without pain, a significant correlation was seen between OSDI and corneal fluorescein staining scores (r_s = 0.67, P =.01). However, such a correlation was not observed in those with ocular pain. Conclusions A majority of patients with DED report some degree of ocular pain, which correlates only moderately with the OSDI score. Severity of ocular pain correlates with nonocular comorbidities such as use of antidepressant medications rather than with clinical signs of DED.