High pain sensitivity and low pain tolerance appear to be associated with symptoms of dry eye disease (DED), adding to previous associations of the severity of tear insufficiency, cell damage, and psychological factors, according to a study by Jelle Vehof, Ph.D., of University Medical Center Groningen, the Netherlands, and colleagues.

A total of 1,635 female twin volunteers, ages 20 to 83 years from the TwinsUK adult registry, participated in the population-based cross-sectional study, and 438 (27 percent) were categorized as having DED. A subset of 689 women completed the Ocular Surface Disease Index (OSDI) questionnaire. Quantitative sensory testing using heat stimulus on the forearm was used to assess pain sensitivity (heat pain threshold [HPT]) and pain tolerance (heat pain suprathreshold [HPST]).

Women with DED showed a significantly lower HPT and HPST - and hence had higher pain sensitivity - than those without DED. A strong significant association between the presence of pain symptoms on the OSDI and the HPT and HPST was found. Participants with an HPT below the median had DED pain symptoms more often than those with HPT above the median (midpoint) (31.2 percent versus 20.5 percent), according to study results.

"Management of DED symptoms is complex, and physicians need to consider the holistic picture, rather than simply treating ocular signs," the authors conclude.