Douleur oculaire : du fondamental à la clinique

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Réaux-Le Goazigo, Annabelle | Melik Parsadaniantz, Stéphane | Baudouin, Christophe | Moreau, Nathan

Edité par CCSD ; Elsevier Masson -

International audience. Chronic ocular pain is very disabling and difficult to treat. Its pathophysiological mechanisms are still poorly understood. The cornea is the most densely innervated tissue in the human body, with an innervation 600 and 40 times higher than that of the skin and dental pulp, respectively. A lesion of corneal nociceptive free nerve endings results in morphological and molecular changes of these free endings, of the corneal neurons located in the trigeminal ganglion but also in brainstem structures (trigeminal sensory complex) involved in corneal nociceptive transmission. Furthermore, various preclinical models of corneal nociception have demonstrated dysfunctions in these anatomical pathways, including peripheral sensitization (hyperactivity of corneal nerves at the level of the terminals and the trigeminal ganglion) and central sensitization (synaptic plasticity, hyperactivity of second-order neurons of the trigeminal sensory complex). Neuroimmune interactions known to shape the excitability of the peripheral and central nervous systems may be the cause of such alterations. Recently, pharmacological studies have identified and validated novel therapeutic targets in different preclinical models of corneal nociception, opening new therapeutic perspectives. In this review, data from basic research are then put into perspective with clinical data, illustrated in particular by the example of dry-eye related pain, a frequent disease encountered in ophthalmological practice. The tools currently used in the clinic to evaluate ocular pain, corneal inflammation and the morphological criteria commonly used to quantify abnormalities (density, tortuosity, neuroma) of corneal nerves will be described. The various therapeutic options for the patient with painful dry eye will also be discussed. In conclusion, research on ocular pain has accelerated in recent years, due to a closer collaboration between researchers and clinicians. The better understanding of chronic ocular pain and therefore improved diagnosis will allow the development of better analgesic strategies tailored to the profile of each patient.

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