Letter to the Editor

Chronic ocular pain

Radhika S. Amin, Eliot N. Haddad and Rony R. Sayegh, MD
Cleveland Clinic Journal of Medicine November 2025, 92 (11) 652; DOI: https://doi.org/10.3949/ccjm.92c.11003

To the Editor: We read with interest the recent review article by Drs. Thapa and Ang1 on nociplastic pain. The authors’ discussion of nociplastic pain parallels recent ophthalmology literature on chronic ocular pain, an underrecognized condition that adversely affects quality of life and interferes with activities of daily living.2 Ocular burning, aching, stinging, grittiness, irritation, sensitivity to wind or light, and pain duration exceeding 3 months are features of chronic ocular pain.3,4

Chronic ocular pain occurs as part of the spectrum of chronic overlapping pain conditions discussed in the article, sharing mechanistic features with other nociplastic pain syndromes. It presents with pain out of proportion to ocular surface findings, which are often absent or minimal, supporting central sensitization and altered pain processing as the underlying mechanism rather than peripheral tissue damage.3–5 Screening questionnaires and scales such as the Ocular Pain Assessment Survey (OPAS), Chronic Ocular Pain Questionnaire (COP-Q), or Numeric Pain Rating Scale (NPRS) can assist with diagnosis.4 Appropriate recognition is crucial because conventional surface-directed therapies like lubricating eyedrops often fail to provide relief, as also seen in other nociplastic conditions. Patients with chronic ocular pain require systemic and multidisciplinary management due to comorbid poor mood, insomnia, and fatigue.3,5,6

The treatment approaches outlined by Thapa and Ang,1 including pharmacologic agents (gabapentinoids, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants) and nonpharmacologic interventions (electrical nerve stimulation, acupuncture, exercise, cognitive-behavioral therapy), apply to patients with chronic ocular pain.4 Increasing awareness of these management options among primary care physicians, ophthalmologists, and other specialists could lead to earlier recognition, more appropriate treatment, and improved quality of life for patients with chronic ocular pain.6

We commend the authors for their article on nociplastic pain and hope that expanding this framework to include chronic ocular pain will further enhance clinical care.

REFERENCES

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    1. Thapa R,
    2. Ang D
    . Nociplastic pain: a practical guide to chronic pain management in the primary care setting. Cleve Clin J Med 2025; 92(4):236–247. doi:10.3949/ccjm.92a.24101
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    1. Sayegh RR,
    2. Yu Y,
    3. Farrar JT, et al
    . Ocular discomfort and quality of life among patients in the dry eye assessment and management study. Cornea 2021; 40(7):869–876. doi:10.1097/ICO.0000000000002580
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    1. De Lott LB,
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    3. Harte S, et al
    . Nociplastic pain among individuals with chronic ocular surface pain: one cause for “pain without stain”? Surv Ophthalmol 2025; 70(3):536–543. doi:10.1016/j.survophthal.2025.01.004
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    4. Attal N,
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    . Understanding chronic ocular surface pain: an unmet need for targeted drug therapy. Ocul Surf 2022; 26:148–156. doi:10.1016/j.jtos.2022.08.005
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    1. Ong ES,
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    3. Levitt RC,
    4. Feuer WJ,
    5. Sarantopoulos CD,
    6. Galor A
    . Epidemiology of discordance between symptoms and signs of dry eye. Br J Ophthalmol 2018; 102(5):674–679. doi:10.1136/bjophthalmol-2017-310633
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    1. Galor A,
    2. De Lott LB
    . A call to abandon the term dry eye when we really mean pain. Ophthalmology Published online July 8, 2025. doi:10.1016/j.ophtha.2025.06.015
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