Ocular neuropathic pain in a real-world patient cohort with dry eye disease: A save sight dry eye registry study

• In a real-world cohort, patient demographics, and clinical signs poorly differentiate dry eye disease (DED) patients with and without ocular neuropathic pain. • The ocular surface disease index (OSDI) and ocular comfort index (OCI) pain-related question, domain and final scores were higher in DED patients with ocular neuropathic pain. • Further studies are required to validate the use of the OSDI and OCI in clinical practice for the diagnosis of ocular neuropathic pain in DED patients. To compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain. A cross-sectional cohort study was performed using the Save Sight Dry Eye Registry (SSDER). Patients were divided into two groups based on a clinician diagnosis of ocular neuropathic pain and Tear Film and Ocular Surface Society Dry Eye Workshop II definitions. Patient demographics, Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) scores, and DED signs were compared along with Patient Health Questionnaire-4 (PHQ-4) scores, average screen time and treatment compliance. Statistical analyses included descriptive statistics, Mann-Whitney U test, Chi-squared test of independence, and Fisher's exact test. P-values were Bonferroni corrected (p*). Data from 298 patients with DED symptoms and signs (26 with ocular neuropathic pain) were analysed. There was no statistical difference in patient demographics (p*>0.0063). Patients with ocular neuropathic pain had worse final, domain, and pain-related question scores for the OSDI (p*<0.0031) and OCI (p*<0.0039) and had higher scores for anxiety and depression for the PHQ-4 (p*<0.0083). Patients with ocular neuropathic pain had a lower rate and severity of meibomian gland dysfunction (p*<0.0063). Real-world data from the SSDER demonstrated patient demographics and clinical signs poorly differentiated patients with ocular neuropathic pain within a DED cohort. Patients with ocular neuropathic pain reported significantly worse OSDI and OCI scores, indicating greater symptom severity. While this highlighted symptom differences, further research is required to determine whether OSDI and OCI scores can assist in identifying ocular neuropathic pain in DED.