Is gabapentin effective in dry eye disease and neuropathic ocular pain?
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LETTER TO THE EDITOR
Is gabapentin effective in dry eye disease and neuropathic ocular pain? Mehmet Cuneyt Ozmen1 Received: 15 November 2019 / Accepted: 20 November 2019 © Belgian Neurological Society 2019
Dear Editor, We read the article by Ongun et al. [1] on the efficacy of gabapentin in dry eye disease (DED) and neuropathic ocular pain. Authors have recruited patients with severe dry eye disease with low Schirmer’s and tear break-up time scores (there is no mention of staining). All patients received artificial tears and cyclosporine A, and only patients with pain, assessed by pain detect questionnaire (PD-Q) received gabapentin in addition to artificial tears and cyclosporine (group 2). According to results, both groups improved in DED signs and symptoms (ocular surface disease index [OSDI]) and group 2 improved more than group 1; thus, the authors conclude that gabapentin is effective in severe dry eye patients with neuropathic ocular pain. As an ophthalmologist working on DED and neuropathic corneal pain (in Hamrah lab at Tufts Medical Center, Center for Translational Ocular Immunology, Boston, USA from 2018 to 2019, currently working at Gazi University Department of Ophthalmology, Ankara, Turkey), we found this study to be very interesting. Neuropathic pain in the eye has been recently come into focus of ophthalmologists and there is no consensus on diagnosis and treatment. However, there are a couple of issues we would like to point out. 1. There is no literature on Neuropathic Corneal Pain that shows the role of glutamate and activation of NMDA receptors. The citation used in this manuscript, [2] is a review paper that described the specific role of glutamate and NMDA receptor for neuropathic pain in nonocular sites. Moreover, personal experience shows low effect of gabapentin on NCP patients as monotherapy. * Mehmet Cuneyt Ozmen [email protected] 1
Department of Ophthalmology, Cornea, Cataract and Refractive Surgery Unit, Gazi University Medical School, Ankara, Turkey
2. The authors cited an article from Lichtinger et al. as reference in the literature for the use of gabapentin in neuropathic corneal pain [3]; however, Lichtinger et al. used gabapentin specifically for the treatment of acute pain after photorefractive keratectomy. Moreover, the medication was given for a very short period of time before and after the surgery, and for this reason, it cannot be considered as a neuromodulatory effect of the drug. 3. It is hard to diagnose patients with neuropathic ocular pain. DEWS II report has stated that neuropathic pain patients do not have DED signs [4]. Neuropathic pain can sometimes be present when there are signs, especially when there is discordance between signs and symptoms as described before [5, 6]. If the DED signs are severe as they are in this study (Schirmer’s
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