Abstract
Dysfunctional coping behaviors, such as catastrophizing, have been implicated in pain severity and chronicity across several pain disorders. However, the impact of dysfunctional coping has not been examined under the context of dry eye (DE). This study evaluates relationships between catastrophizing and measures of DE, including pain severity and pain-related daily interference. The population consisted of patients seen at Miami Veterans Affairs eye clinic between April 2016 and October 2017. Patients filled out standardized questionnaires assessing symptoms of DE and eye pain, non-ocular pain, mental health, coping behaviors (Pain Catastrophizing Scale, PCS), and pain-related daily interference as a perceived impact on quality of life (Multidimensional Pain Inventory, Interference Subscale, MPI-Interference), and all patients underwent an ocular surface examination. In total, 194 patients participated, with a mean age of 58.8 ± 9.6 years, the majority being male, non-Hispanic, and black. PCS (catastrophizing) was correlated with DE symptom severity, including Dry-Eye Questionnaire 5 (DEQ5; r = 0.41, p < 0.0005), Ocular Surface Disease Index (OSDI; r = 0.40, p < 0.0005), and neuropathic-like eye pain (Neuropathic Pain Symptom Inventory-Eye (NPSI-Eye; r = 0.48, p < 0.0005). Most tear metrics, on the other hand, did not correlate with PCS. Linear regressions showed that PCS, non-ocular pain intensity, and number of pain conditions were significant predictors of DEQ5 (overall DE symptoms), while PCS and non-ocular pain intensity were predictors of NPSI-Eye scores, as were insomnia scores and analgesic use. In a separate analysis, PCS and DE symptoms (OSDI) associated with pain-related interference (MPI-Interference) along with non-ocular pain intensity, post-traumatic stress disorder (PTSD), number of pain conditions, and non-Hispanic ethnicity. These findings suggest that catastrophizing is not significantly related to signs of DE, but is strongly associated to pain-related symptoms of DE and daily interference due to pain.
Highlights
Dry eye (DE) is a common, multifactorial disease that can result from abnormal tear film, ocular surface, and somatosensory pathways
Considering the demographics, ocular parameters, and co-morbidities that were significantly correlated in regression models, we found that average non-ocular pain intensity, number of pain conditions, and catastrophizing (PCS) explained 30% of variability in Dry Eye Questionnaire 5 (DEQ5) (R = 0.55)
The majority of current therapies focus on improving ocular surface pathologies to alleviate symptoms, while our results indicate a potential utility in targeting behavioral and systemic findings
Summary
Dry eye (DE) is a common, multifactorial disease that can result from abnormal tear film, ocular surface, and somatosensory pathways. DE symptoms are a source of significant morbidity, causing chronic sensations of pain, described in terms of “dryness”, “burning”, and “irritation” ( referred to as pain-related DE symptoms) and fluctuations or loss of vision (vision-related symptoms). Together, these symptoms can negatively impact physical and mental functioning [1,2]. These symptoms can negatively impact physical and mental functioning [1,2] In this regard, DE has much in common with chronic pain disorders outside the eye, with chronic neuropathic pain conditions [3]. Similar factors have been implicated in the report of DE, as anxiety and depression both significantly correlated with DE diagnosis and symptom severity [9,10,11]
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