Dry Eye Symptoms and Pain Sensitivity

MedicalResearch.com Interview with: Jelle Vehof PhD

Department of Twin Research & Genetic Epidemiology
King’s College London, St Thomas’ Hospital, Waterloo, London, England
Department of Ophthalmology & Epidemiology
University Medical Center Groningen, Groningen, the Netherlands

MedicalResearch.com: What are the main findings of the study?

Dr. Vehof: The current study provides the first empirical evidence that individuals with dry eye disease show altered pain sensitivity. Specifically, this study demonstrates that subjects with DED pain and discomfort complaints have lower pain threshold and pain tolerance of heat-based stimulus compared to those without.

These findings support the hypothesis that a subset of persons with DED is more sensitive to pain.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Vehof: It is well known that ocular signs do not correlate with dry eye symptoms in clinic. So other factors must play a role as well. We were surprised by the big effect size. Patients with higher pain sensitivity than median show almost twice as often dry eye pain symptoms than patients with a lower pain sensitivity than median.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Vehof:  Finding no ocular signs of dry eye does not mean that the patient does not have any symptoms. For example, minor ocular surface abnormalities that are not clearly demonstrated by the regular dry eye tests might be sufficient to cause symptoms in patients with high pain sensitivity. We think explaining this to patients is important in the management of dry eye. It may be that future treatments may need to take this into account, if patients with other chronic pain conditions that have low pain tolerance are shown to respond, for example, to non-pharmacologic treatments such as CBT.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Vehof:  This is discussed in the second paragraph of the discussion. We are currently investigating whether patients that do not have ocular signs but do have dry eye symptoms show higher pain sensitivity than patients with ocular signs and we are investigating how much of the variation in dry eye symptoms is explained by pain sensitivity compared to ocular signs such as tear osmolarity, Schirmer value and tear break up time.


Vehof J, Kozareva D, Hysi PG, et al. Relationship Between Dry Eye Symptoms and Pain Sensitivity. JAMA Ophthalmol. 2013;():-. doi:10.1001/jamaophthalmol.2013.4399.

Last Updated on September 19, 2013 by Marie Benz MD FAAD