Symptoms and signs of dry eye in US veterans with Myalgic encephalomyelitis/chronic fatigue syndrome, 2023, V. Sanchez et al

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

Purpose : Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is clinically defined as persistent and unexplainable post-exertional fatigue and can present with a wide range of cognitive, immunological, endocrinological, and autonomic symptoms. A notable feature of ME/CFS is its comorbidity with pain in multiple compartments. In this study, we examine ocular manifestations associated with ME/CFS, with a focus on ocular surface pain complaints.

Methods : We recruited 124 United States veterans and profiled them for symptoms and signs of dry eye (DE). Individuals were grouped by the presence (n=42) and absence (n=82) of ME/CFS.

Results : The mean age of the population was 55.49 ± 4.61 years, 88.7% of participants identified as male, 58.1% as White, and 39.5% as Hispanic. Demographics, medical comorbidities, and medication use were similar between groups except for depression (57.1% vs. 29.6%, p=0.003), and history of traumatic brain injury (9.5% vs. 1.2%, p=0.03) which were more prevalent in the ME/CFS group. Individuals with ME/CFS reported higher ocular surface pain complaints, both through DE specific questionnaires (Ocular Surface Disease Index, OSDI; 5-Item DE Questionnaire, DEQ-5) and pain specific questionnaires (Neuropathic Pain Symptom Inventory, modified for the Eye, NPSI-E; Numerical rating scale, NRS) (Table 1). Ocular surface parameters were similar between groups, except for persistent pain after topical anesthesia which was more frequent in the ME/CFS group (Table 2).

Conclusions : Individuals who met criteria for ME/CFS had more severe ocular surface pain, but similar signs of DE, compared to controls. This suggests that nerve, and not tear, abnormalities contribute to ocular surface pain in ME/CFS.

https://iovs.arvojournals.org/article.aspx?articleid=2790532

 

A couple of tables with dry eye and pain scores at the link but not much more

Diagnostic criteria and how/if they differentiate from GWI not specified and they use the term post-exertional fatigue in the abstract

Odd demographics (for ME/CFS) due to cohort being veterans

Bit surprised by the findings. I've seen the occasional complaint by pwME about dry eye but here they found no difference. On the other hand I can't recall pwME discussing surface ocular pain yet here they did find a difference

But hey, if this gets more opthalmologists interested in looking at ME, that's got to be a good thing

 

I would love that as I have eye pain as one of my most significant symptoms.

 

Eye pain is with me all day, every day. I have all four tear ducts plugged as well.

Edit: and apparently no auto-immune disease or any specific cause. It may have worsened with age but it started in my 30s. I had ME then.

 

EDIT: please tell me that the dry eye was actually measured by looking at it with microscope, because I'm wondering why there are questionnaire results for dry eye, when I wouldn't necessarily have noticed before I saw an opthamologist I had these - just itchy and sore etc. Surely they'd use the standard proper tests to check the questionnaire wasn't missing it?

I have dry eyes - diagnosed by an opthamologist (and they are hyper allergic too). One frustrating thing, as I by the time of my appointment was obviously aware of sjogrens, is that when I asked (about Sjogrens) I was just told 'well the treatment is the same anyway so we don't test'.

Which might (?) be true for the optometry side of things but isn't it slightly relevant for the then feeding back into the bigger picture of symptoms side of things and what might be possible/relevant there?

Or has that become another condition where the chicken-egg stagnation to nowhere is being used: as long as you can keep it so there is no treatment then mapping who has it isn't worth it?

I'm sure I've heard that for other things too (not just ME, in fact CFS was the one pot they did want to dump me into - with the full intention of that meaning they then did no invesigations or treatments then)

How accurate are these NHS records?

And ergo how warped are these calculations of 'demand' and numbers will different conditions, or in general if not discovered yet they might know the approx 'arena' e.g. 'autoimmune something' that apparently relate to all sorts of decisions on resource?

They bang on about was it deep something when they were thinking of selling it as data being some sort of wonder set of records but it seems like we've a political situaion of the tail-wagging-the-dog and that has been thoroughly played by certain groups of individuals. As well as leading to a disproportionate workforce distribution almost certainly by keeping may who might be categorised to have a specialism and therefore research money following it, under some generic that is being sucked up by psychsomaticists programmes?

So it isn't even about a test really ... there needs to be a more co-ordinated and well put-together pitch of why the prognosis and follow-up/responsibility under a clinician long-term to see what does and doesn't work is needed too. And of course this needs to not be a malign bunch who aren't scientists but churn out cheap retrospective surveys from any old person in the canteen so they can produce 20 a year that say what they need (and chuck any others that don't in the bin).

But vice versa for some reason the 'why' of doing that has to be done for certain conditions and I wonder how much this naif naff accounting '6mnths results on the doors' thing needs to be somehow countered as not conducive to scientific UK medicine making developments or innovations etc. which I guess is where the nonsense recovery language got developed.

Harder to pull that blag with dry eyes which will be less dry with drops than without but not cured and not necessarily stopped from declining in future. Because .. research into underlying cause etc. oh and them being able to see the eye and dryness under the microscope/objective measure but still... something's going on

 

Free full text:
https://onlinelibrary.wiley.com/doi/10.1111/ceo.14313

ORIGINAL ARTICLE
Open Access
Dry eye symptoms and signs in United States Gulf War era veterans with myalgic encephalomyelitis/chronic fatigue syndrome

Victor Sanchez BS, Colin K. Kim BS, Elyana V. T. Locatelli BS, Adam K. Cohen, Kimberly Cabrera MS, Kristina Aenlle PhD, Nancy G. Klimas MD, Robert O'Brien PhD, Anat Galor MD, MSPH
First published: 12 November 2023

https://doi.org/10.1111/ceo.14313



Abstract
Background
To examine ocular symptoms and signs of veterans with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) diagnosis, ME/CFS symptoms, and controls.

Methods
This was a prospective, cross-sectional study of 124 South Florida veterans in active duty during the Gulf War era. Participants were recruited at an ophthalmology clinic at the Miami Veterans Affairs Hospital and evaluated for a diagnosis of ME/CFS, or symptoms of ME/CFS (intermediate fatigue, IF) using the Canadian Consensus criteria. Ocular symptoms were assessed via standardised questionnaires and signs via comprehensive slit lamp examination. Inflammatory blood markers were analysed and compared across groups.

Results
Mean age was 55.1 ± 4.7 years, 88.7% identified as male, 58.1% as White, and 39.5% as Hispanic. Ocular symptoms were more severe in the ME/CFS (n = 32) and IF (n = 48) groups compared to controls (n = 44) across dry eye (DE; Ocular Surface Disease Index [OSDI]: 48.9 ± 22.3 vs. 38.8 ± 23.3 vs. 19.1 ± 17.8, p < 0.001; 5 item Dry Eye Questionnaire [DEQ-5]: 10.8 ± 3.9 vs. 10.0 ± 4.6 vs. 6.6 ± 4.2, p < 0.001) and pain-specific questionnaires (Numerical Rating Scale 1-10 [NRS] right now: 2.4 ± 2.8 vs. 2.4 ± 2.9 vs 0.9 ± 1.5; p = 0.007; Neuropathic Pain Symptom Inventory modified for the Eye [NPSI-E]: 23.0 ± 18.6 vs. 19.8 ± 19.1 vs. 6.5 ± 9.0, p < 0.001). Ocular surface parameters and blood markers of inflammation were generally similar across groups.

Conclusion
Individuals with ME/CFS report increased ocular pain but similar DE signs, suggesting that mechanisms beyond the ocular surface contribute to symptoms.

 

Sjogren's is an autoimmune disease. If someone has one autoimmune disease they have a higher risk of developing another one. Surely this should be considered useful information for the patient's future health if they ever develop new symptoms? I would agree this is very frustrating, but I would guess it is another money-saving thing.