Noninvasive Electrical Stimulation for the Treatment of Chronic Ocular Pain and Photophobia

Eellan Sivanesan, Roy C. Levitt, Constantine D. Sarantopoulos, Dennis Patin, Anat Galor

Research output: Contribution to journalArticle

Abstract

Introduction: "Dry eye" or "keratoconjunctivitis sicca" is a multifactorial disease estimated to have a worldwide prevalence of 5-33%. Conventional therapies targeting the ocular surface with artificial tears, anti-inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic-like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals. Methods: All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic-like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre-treatment and five min post-treatment via a two-tailed paired Student's t-test. Results: The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p<0.05, paired t-test). The use of TENS significantly decreased light sensitivity in both eyes (p<0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p<0.05, paired t-test). Discussion: Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal-thalamic-cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.

Original languageEnglish (US)
JournalNeuromodulation
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Eye Pain
Photophobia
Chronic Pain
Electric Stimulation
Transcutaneous Electric Nerve Stimulation
Therapeutics
Keratoconjunctivitis Sicca
Veterans Hospitals
Pain Clinics
United States Department of Veterans Affairs
Hyperalgesia
Eyelids
Hygiene
Tears
Analgesia
Anti-Inflammatory Agents
Prospective Studies
Students
Anti-Bacterial Agents

Keywords

  • Dry eye
  • Neuromodulation
  • Ocular pain
  • Photophobia
  • Transcutaneous electrical stimulation

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Noninvasive Electrical Stimulation for the Treatment of Chronic Ocular Pain and Photophobia. / Sivanesan, Eellan; Levitt, Roy C.; Sarantopoulos, Constantine D.; Patin, Dennis; Galor, Anat.

In: Neuromodulation, 01.01.2018.

Research output: Contribution to journalArticle

Sivanesan, Eellan ; Levitt, Roy C. ; Sarantopoulos, Constantine D. ; Patin, Dennis ; Galor, Anat. / Noninvasive Electrical Stimulation for the Treatment of Chronic Ocular Pain and Photophobia. In: Neuromodulation. 2018.
@article{37c2d3383cc1496facbf277ef23e358e,
title = "Noninvasive Electrical Stimulation for the Treatment of Chronic Ocular Pain and Photophobia",
abstract = "Introduction: {"}Dry eye{"} or {"}keratoconjunctivitis sicca{"} is a multifactorial disease estimated to have a worldwide prevalence of 5-33{\%}. Conventional therapies targeting the ocular surface with artificial tears, anti-inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic-like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals. Methods: All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic-like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre-treatment and five min post-treatment via a two-tailed paired Student's t-test. Results: The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p<0.05, paired t-test). The use of TENS significantly decreased light sensitivity in both eyes (p<0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p<0.05, paired t-test). Discussion: Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal-thalamic-cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.",
keywords = "Dry eye, Neuromodulation, Ocular pain, Photophobia, Transcutaneous electrical stimulation",
author = "Eellan Sivanesan and Levitt, {Roy C.} and Sarantopoulos, {Constantine D.} and Dennis Patin and Anat Galor",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/ner.12742",
language = "English (US)",
journal = "Neuromodulation",
issn = "1094-7159",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Noninvasive Electrical Stimulation for the Treatment of Chronic Ocular Pain and Photophobia

AU - Sivanesan, Eellan

AU - Levitt, Roy C.

AU - Sarantopoulos, Constantine D.

AU - Patin, Dennis

AU - Galor, Anat

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: "Dry eye" or "keratoconjunctivitis sicca" is a multifactorial disease estimated to have a worldwide prevalence of 5-33%. Conventional therapies targeting the ocular surface with artificial tears, anti-inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic-like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals. Methods: All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic-like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre-treatment and five min post-treatment via a two-tailed paired Student's t-test. Results: The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p<0.05, paired t-test). The use of TENS significantly decreased light sensitivity in both eyes (p<0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p<0.05, paired t-test). Discussion: Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal-thalamic-cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.

AB - Introduction: "Dry eye" or "keratoconjunctivitis sicca" is a multifactorial disease estimated to have a worldwide prevalence of 5-33%. Conventional therapies targeting the ocular surface with artificial tears, anti-inflammatories, punctal closure, eyelid hygiene, and antibiotics do not provide relief in all patients, especially those with neuropathic-like ocular complaints (wind hyperalgesia and photophobia). We anticipated that ocular transcutaneous electrical nerve stimulation (TENS) would alleviate symptoms of ocular pain, photophobia, and dryness in these latter individuals. Methods: All individuals who received electrical stimulation between May 10, 2016 and April 6, 2017 for the treatment of chronic ocular pain at the oculofacial pain clinic of the Miami Veterans Administration Hospital were included in this retrospective review. All patients had symptoms of dryness along with other neuropathic-like symptoms (e.g., photophobia) and minimal signs of tear dysfunction. Ocular pain intensity, symptoms of dryness, and light sensitivity were compared pre-treatment and five min post-treatment via a two-tailed paired Student's t-test. Results: The use of TENS significantly reduced the mean pain intensity in both the right and left eyes five min after treatment compared to prior to treatment (p<0.05, paired t-test). The use of TENS significantly decreased light sensitivity in both eyes (p<0.05). The findings for symptoms of dryness, however, were equivocal with a significant decrease in the left eye but not the right (p<0.05, paired t-test). Discussion: Our data indicate that TENS may similarly provide analgesia in patients with dry eye symptoms as it does for many other chronic pain conditions. Furthermore, the noted effect on symptoms of photophobia and dryness suggest that all may be linked by similar trigeminal-thalamic-cortical pathways. Prospective studies with electrical stimulation of dry eye are needed to further elucidate its benefit and mechanism of action.

KW - Dry eye

KW - Neuromodulation

KW - Ocular pain

KW - Photophobia

KW - Transcutaneous electrical stimulation

UR - http://www.scopus.com/inward/record.url?scp=85039550072&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85039550072&partnerID=8YFLogxK

U2 - 10.1111/ner.12742

DO - 10.1111/ner.12742

M3 - Article

C2 - 29283468

AN - SCOPUS:85039550072

JO - Neuromodulation

JF - Neuromodulation

SN - 1094-7159

ER -