Management of Neuropathic Ocular Pain Associated with Dry Eye Disease in a 5-Year Prospective Cohort

Purpose: This study aimed to assess the long-term management and 5-year evolution of patients with neuropathic ocular pain (NOP) associated with chronic dry eye disease (DED). Methods: Fourteen patients with NOP underwent a 5-year follow-up. Baseline and 5-year assessments included questionnaires on dry eye (Dry Eye Questionnaire 5 [DEQ-5] and Ocular Surface Disease Index), pain (Brief Pain Inventory [BPI]), anxiety/depression disorders (Hospital Anxiety and Depression Scale), and a dedicated questionnaire on NOP characteristics (Neuropathic Ocular Pain Questionnaire), which was developed for this study. Treatment tolerance and effectiveness were rated on a 0–5 scale. Clinical examination, meibography, tear film analysis, corneal nerve density, and inflammation assessment using in vivo confocal microscopy (IVCM) were performed at both time points. Results: Patients were predominantly women (93%) with a mean age of 41 ± 17 years. High rates of comorbid anxiety/depressive disorders (85.7%) and diffuse chronic pain (35.7%) were observed, supporting the need for multimodal care. Over 5 years, significant improvements occurred in mean neuropathic pain scores ( P = 0.005), BPI scores ( P = 0.003), and DEQ-5 scores ( P = 0.041). Clinical parameters remained unchanged, except for a significant decrease in IVCM inflammation score ( P = 0.004). All patients received topical ophthalmic treatments; 78.6% were treated with systemic neuropathic pain relievers, and 64.3% received psychological care. The most effective treatments included artificial tears, cyclosporine eye drops, scleral lenses, oral therapies, and autologous serum eye drops. Conclusion: This study provides the first long-term overview of therapeutic strategies for NOP associated with DED. Findings support a multidisciplinary approach using specific questionnaires and personalized, long-term treatments. However, controlled prospective studies are needed to establish the efficacy of specific therapeutic strategies.