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Gabapentin (GBT) is a structural analog of gamma-amino butyric acid that has been used by systemic administration to provide pain relief in glaucomatous patients. We have already shown in a rabbit model system that its topic administration as eye drops has anti-inflammatory properties. There are no reports specifically on psychologic treatment of dry eye, corneal pain, or ocular surface pain. Patient with corneal projected pain may resistant to the idea that psychological approaches will be helpful. Clinical Perspectives. Pain management is field with no simple solutions. Keywords: gabapentin; dry eye; neuropathic pain. 1. Introduction. Dry eye (DE) is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of. A recent study reported that oral gabapentin may be able to successfully treat DED patients with neuropathic ocular pain—as opposed to pain mainly caused by mechanical and chemical influences—who have systemic comorbidities, including rheumatological, neurological and psychological disorders. Oral gabapentin is a first-line treatment for chronic systemic neuropathic pain. Although it has been used for ocular discomfort after refractive surgery and in severe, painful dry eye syndrome (DES), it can depress the central nervous system. Generally, if the ocular pain cannot be resolved with topical treatment, other specific causes should be suspected, in particular, neuropathic pain could be the underlying cause [3,4]. In DE, ocular pain disproportionally outweighing the clinical signs is suggestive of underlying neuropathic ocular pain (NOP) nature . Keywords: neuropathic ocular pain, dry eye syndrome, corneal sensitivity, lacrimal gland, autonomous nervous system, aquaporin 5, corneal epithelial cells, PKA/CREB pathway. Citation: Cammalleri M, Amato R, Olivieri M, Pezzino S, Bagnoli P, Dal Monte M and Rusciano D (2021) Effects of Topical Gabapentin on Ocular Pain and Tear Secretion. Front. Preclinical evidence about the efficacy of topical gabapentin on neuropathic ocular pain is provided by Cammalleri et al. in a rabbit model system in which eye drops with gabapentin exert analgesic effects coupled to stimulation of tear secretion. Secretagogue efficacy of gabapentin involves both a stimulation of the autonomic nervous system “[It] can tackle dry eye disease and neuropathic pain from two angles,” explains Rusciano. “As an analgesic, it dulls pain without interfering with lacrimation; as a 'secretagogue' it can stimulate lacrimation, which is the main defect in dry eye.” Abstract title: Effects of topical gabapentin on ocular pain and tear secretion We report a 37-year-old male presenting with constant left eye pain associated with headaches, whose pain was successfully reduced after 3 weeks of treatment with gabapentin. Our case and literature review highlight the importance of gabapentin and thorough psychosocial evaluations in patients with chronic neuropathic ocular pain. Following 4 and 6 months of treatment with autologous serum tears and low-dose anti-inflammatory therapy (1B, 1D), subbasal corneal nerve density is increased, and microneuromas are no longer present. Signs and symptoms. Currently, there are no standard clinical criteria and no ocular sensory tests that are diagnostic. Both drugs are approved to treat epilepsy and selected chronic pain conditions and are widely used off-label for mood disorders and pain. 2 “We were surprised that this commonly prescribed psychotropic agent might increase the risk of AAG,” said coauthor Mahyar Etminan, PharmD, MSc, at the University of British Columbia Eye Care Center Purpose: To investigate the response to gabapentin treatment in patients with dry eye (DE) accompanied by features of neuropathic ocular pain (NOP), and to analyze the differences between clinical manifestations of the groups according to treatment response. Methods: We retrospectively reviewed the records of 35 patients with DE accompanied by NOP features and obtained information on their Dry eye patients should be screened for neuropathic ocular pain symptoms and individualized treatment has to be applied. Our study showed that the use of gabapentin is effective in severe dry eye patients with neuropathic ocular pain. Purpose: To investigate the response to gabapentin treatment in patients with dry eye (DE) accompanied by features of neuropathic ocular pain (NOP), and to analyze the differences between clinical manifestations of the groups according to treatment response. In our study, first time in literature, we used gabapentin to ameliorate symptoms of neuropathic ocular pain in DED. Our results also can be an evidence for a central disorder perhaps with central sensitization as the underlying mechanism for neuropathic ocular pain in dry eye patients. Gabapentin may be an underutilized medication in the treatment of chronic ocular pain. The pathophysiology of neuropathic ocular pain remains poorly understood. Clinical evaluation often reveals minimal ophthalmic exam findings, leading to an underdiagnosis of the condition by ophthalmologists. Gabapentin (GBT) is a structural analog of gamma-amino butyric acid that has been used by systemic administration to provide pain relief in glaucomatous patients. We have already shown in a rabbit model system that its topic administration as eye drops has anti-inflammatory properties. Looking at the OPAS scores post-treatment, the gabapentin response group showed improvements in ocular pain severity, non-ocular pain severity and quality of life. Gabapentin can relieve neuropathic pain and general systemic symptoms, such as mood, sleep and vasomotor factors, which could explain the significant improvement in non-ocular pain Though Gabapentin remains well established as a first-line treatment for diabetic neuropathy, 14, 15 few randomized control studies have examined the utility of the drug in corneal neuropathic pain. 16 Ongun et al. showed a decrease in patient reported pain in a cohort of patients with chronic corneal neuropathic pain and dry eye disease
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