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. 2020 Oct;18(4):814-820.
doi: 10.1016/j.jtos.2020.08.006. Epub 2020 Aug 27.

Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

M Cuneyt Ozmen  1 , Gabriela Dieckmann  1 , Stephanie M Cox  1 , Ramy Rashad  2 , Rumzah Paracha  2 , Nedda Sanayei  2 , Melina I Morkin  1 , Pedram Hamrah  3
Affiliations

Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

M Cuneyt Ozmen et al. Ocul Surf. 2020 Oct.

Abstract

Purpose: Neuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with a centralized component of pain. This study aims to assess the efficacy and tolerability of the tricyclic antidepressant, nortriptyline, among NCP patients.

Methods: Patients with clinically diagnosed NCP and a centralized component of pain, treated with oral nortriptyline, who had recorded pain scores as assessed by the ocular pain assessment survey at the first and last visit were included. Patients were excluded if they had any other ocular pathology that might result in pain or had less than 4 weeks of nortriptyline use. Demographics, time between visits, concomitant medications, systemic and ocular co-morbidities, duration of NCP, side effects, ocular pain scores, and quality of life (QoL) assessment were recorded.

Results: Thirty patients with a mean age of 53.1 ± 18.5 were included. Male to female ratio was 8:22. Mean ocular pain in the past 24 h improved from 5.7 ± 2.1 to 3.6 ± 2.1 after 10.5 ± 9.1 months (p < 0.0001). Twelve patients (40.0%) had equal to or more than 50% improvement, 6 patients (20.0%) had 30-49% improvement, 6 patients (20.0%) had 1-29% improvement, 4 patients (13.3%) did not improve, while 2 patients (6.7%) reported increase in pain levels. Mean QoL improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p = 0.019). Eight patients (26.6%) discontinued treatment due to persistent side effects, despite improvement by 22.4%.

Conclusion: Nortriptyline was effective in relieving NCP symptoms in patients with centralized component and insufficient response to other systemic and topical therapies who tolerated the drug for at least 4 weeks. Nortriptyline may be used in the management of patients with NCP.

Keywords: Dry eye disease; Neuropathic corneal pain; Nortriptyline; Sensitization; Tricyclic antideppressant.

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Conflict of interest statement

No conflicting relationship exists for any author.

Figures

Figure 1.
Figure 1.
Mean pain scores in first and last visits (error bars represent standard error of means).
See this image and copyright information in PMC

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