Differentiation of Clinical Phenotypes of Inflammatory and Neuropathic Ocular Pain Conditions with Morphologic Measures and Functional Brain Imaging

慢性眼痛是一种非常令人痛苦的症状，因为它的发生会导致高发病率而不是有效的 治疗。干眼症(DE)患者通常有疼痛的眼部症状，但神经机制 这种类型的疼痛可能包括炎症性(如干燥综合征)和/或神经病理性疼痛 影响因素(如神经性眼痛[NOP])。角膜由三叉神经支配，三叉神经 将外周输入传递到中枢神经系统。使用神经影像评估周围神经 棘上结构，我们建议定义三叉神经回路的结构和功能的差异 区分炎症性疼痛和神经病理性疼痛。在目标1中，我们将确定三叉神经病理。 在活体角膜神经定量感觉测试(QST)中，干燥综合征患者与NOP患者和对照组的比较 显微镜(IVCM)和弥散张量成像(DTI)。在目标2中，我们将定义Sjogren 比较中枢神经系统对光诱导通路的功能反应与NOP 使用功能磁共振成像与畏光相关，使用磁共振成像和DTI结构。这项研究可能会得出(1) 结构和功能诊断标记物用于区分炎性和神经性眼痛 神经成像，以及(2)表现为神经性眼痛的神经源性疼痛症状。数据 从这项调查中产生的数据可以用来改进对患者的诊断和监测 为临床决策提供客观指标。

Chronic ocular pain is a highly distressing symptom as its occurrence results in high morbidity without effective treatment. Patients with dry eye (DE) commonly have painful ocular symptoms, yet the neural mechanisms underlying this type of pain may include inflammatory (as in Sjogren's syndrome) and/or neuropathic contributors (as in neuropathic ocular pain [NOP]). The cornea is innervated by the trigeminal nerve, which conveys peripheral input to the central nervous system. Using neuroimaging to evaluate peripheral nerves to supraspinal structures, we propose to define the structural and functional differences in the trigeminal circuit that differentiate inflammatory and neuropathic pain. In aim 1, we will determine trigeminal nerve pathology in persons with Sjogren's vs. NOP vs. controls using quantitative sensory testing (QST), in vivo corneal nerve microscopy (IVCM), and diffusion tensor imaging (DTI). In aim 2, we will define differences between Sjogren's vs. NOP in the central nervous system by comparing functional responses to light-induced pathways associated with photophobia using fMRI, and structure using MRI and DTI. This study is likely to yield (1) structural and functional diagnostic markers to differentiate inflammatory and neuropathic ocular pain with neuroimaging, and (2) evince a neurological source of pain symptoms with neuropathic ocular pain. Data generated from this investigation may be used to improve the diagnosis and monitoring of patients suffering from chronic ocular pain, and provide an objective marker to base clinical decision making.