Ocular surface pain was originally placed under the umbrella term “dry eye” (DE) but is now recognized as its own entity, with tear film abnormalities as one of many potential contributors to patient symptoms. This is an important problem to tackle as ocular surface pain is estimated to affect 5% to 50% of US and international populations, depending on the definition of symptoms and the population studied. Furthermore, ocular surface pain leads to significant morbidity, with negative impacts on mental health and the ability to work.

This book examines the many contributors to ocular surface pain, with a focus on diagnostic pathways and individualized treatment plans. In short, ocular surface pain should be evaluated considering potential nociceptive and neuropathic etiologies, as this approach can aid in developing an individualized intervention plan. Nociceptive pain refers to direct activation of sensory pain fibers due to damage to non-neural tissue. In the eye, many nociceptive triggers such as trauma, low tear production, or surgery can lead to nociceptive ocular surface pain. Neuropathic pain is caused by a lesion or disease affecting the somatosensory pathway. Maladaptive healing after trauma or surgery, or prolonged nociceptive triggers (e.g., aqueous tear deficiency, ocular surface inflammation) can lead to peripheral and/or central nerve abnormalities that manifest with persistent ocular surface pain. However, the two entities are not mutually exclusive.

Ocular Surface Pain is a must-have resource for ophthalmologists as well as physicians and specialists in the fields of neurology, psychiatry, rheumatology, and optometry.

Anat Galor, M.D., is an expert in ocular surface pain, dry eye, and neuropathic ocular pain. Her work has helped define how nerve dysfunction contributes to dry eye symptoms and why symptoms and clinical signs are often discordant. After first demonstrating that dry eye symptoms and signs do not always align, Dr. Galor investigated whether nerve sensitization could explain this mismatch. She showed that many dry eye symptoms, including burning and sensitivity to wind and light, overlap with symptoms seen in chronic pain conditions outside the eye. She further tested this hypothesis by measuring nerve sensitivity in both the cornea and forearm, demonstrating that individuals with dry eye symptoms and ocular pain can have increased sensitivity locally, at the cornea, and remotely, outside the eye.

Building on these findings, Dr. Galor has evaluated whether treatments used for non-ocular pain may also benefit patients with dry eye symptoms and ocular pain. Her studies have examined therapies including gabapentinoids, periocular injections, and transcutaneous electrical stimulation. She is also an expert in the epidemiology and treatment of persistent pain after LASIK and has focused on how ocular surface symptoms, including pain, affect quality of life. Through this work, she has developed novel diagnostic and therapeutic approaches for dry eye symptoms and ocular pain related to nerve sensitization. She has published extensively in high-impact ophthalmology and pain journals and was named to The Ophthalmologist Power List in 2021.