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

慢性眼部疼痛是一种非常令人痛苦的症状，因为其发生导致高发病率，而没有有效的治疗方法。 治疗干眼症（DE）患者通常有疼痛的眼部症状，但神经机制 潜在的这种类型的疼痛可以包括炎性（如在干燥综合征中）和/或神经性疼痛 （如神经性眼痛[NOP]）。角膜受三叉神经支配， 将外围输入传递到中枢神经系统。使用神经影像学评估周围神经， 棘上结构，我们建议定义三叉神经回路的结构和功能差异 区分炎症性疼痛和神经性疼痛。在目标1中，我们将确定三叉神经病理学， 使用定量感觉测试（QST），体内角膜神经， 显微镜（IVCM）和扩散张量成像（DTI）。在目标2中，我们将定义干燥综合征与 vs.通过比较光诱导途径的功能反应，研究中枢神经系统中的NOP 与恐惧症相关的功能性磁共振成像，以及与结构相关的磁共振成像和弥散张量成像。该研究可能会产生（1） 用于区分炎性和神经性眼痛的结构和功能诊断标记物 神经成像，和（2）显示神经源性眼痛的疼痛症状。数据 从这项研究中产生的信息可以用于改善对患有癌症的患者的诊断和监测。 从慢性眼部疼痛，并提供一个客观的标志，以基础临床决策。

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.