Fishman comments: Dr. Galor continues to be one the TOP academic physician/ researchers in the area of dry eye and neuropathic pain. This article from 2017 by Dr. Galor et al. does a terrific job of summarizing the mechanisms, treatments and challenges of neuropathic pain and dry eye and how they are inextricably related. The take home message for me is that eye pain can originate from local ocular surface findings – so called nociceptive pain  (like inflamed corneal nerves, recurrent erosions, superior limbic keratoconjunctivitis, etc.) and then switch over to neuropathic pain which is an abnormal signaling of the nervous system. The key is for the physician to determine if the pain is nociceptive, neuropathic, or both.

Authors:  Anat Galor, MD, MSPH, Hamid-Reza Moein, MD, Charity Lee, BS, Adriana Rodriguez, MD, Elizabeth R. Felix, PhD, Konstantinos D. Sarantopoulos, MD, PhD, and Roy C. Levitt, MD

Abstract: Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.