Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans

Charity J. Lee, Elizabeth Felix, Roy C Levitt, Christopher Eddy, Elizabeth A. Vanner, William J Feuer, Konstantinos D. Sarantopoulos, Anat Galor

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Aims The purpose of the study is to evaluate the relationship between dry eye (DE) and pain diagnoses in US veterans with and without traumatic brain injury (TBI). Methods Retrospective cohort study of veterans who were seen in the Veterans Administration Hospital (VA) between 1 January 2010 and 31 December 2014. Veterans were separated into two groups by the presence or absence of an International Classification of Diseases, Ninth Revision diagnosis of TBI and assessed for DE and other comorbidities. A dendrogram was used to investigate the linkage between TBI, DE, chronic pain and other comorbid conditions. Results Of the 3 265 894 veterans seen during the 5-year period, 3.97% carried a diagnosis of TBI. Veterans with TBI were more likely to have a diagnosis of DE compared with their counterparts without TBI (37.2% vs 29.1%, p<0.0005). The association was stronger between TBI and ocular pain (OR 3.08; 95% CI 3.03 to 3.13) compared with tear film dysfunction (OR 1.09; 95% CI 1.07 to 1.10). Those with TBI were also about twice as likely to have a diagnosis of chronic pain, headache, depression or post-traumatic stress disorder compared with their counterparts without TBI. Cluster analysis of TBI, DE and pain diagnoses of interest revealed that central pain syndrome, cluster headache, sicca syndrome, keratoconjunctivitis sicca and late effect of injury to the nervous system (as can be seen after TBI) were all closely clustered together. Conclusions DE and pain disorders occur at higher frequencies in patients with a diagnosis of TBI, suggesting a common underlying pathophysiology.

Original languageEnglish (US)
Pages (from-to)667-673
Number of pages7
JournalBritish Journal of Ophthalmology
Volume102
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Eye Pain
Veterans
Headache Disorders
Chronic Pain
Traumatic Brain Injury
Keratoconjunctivitis Sicca
Nervous System Trauma
Veterans Hospitals
United States Department of Veterans Affairs
Somatoform Disorders
Sjogren's Syndrome
International Classification of Diseases
Post-Traumatic Stress Disorders
Tears

Keywords

  • Epidemiology
  • Ocular Surface
  • Public Health

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans. / Lee, Charity J.; Felix, Elizabeth; Levitt, Roy C; Eddy, Christopher; Vanner, Elizabeth A.; Feuer, William J; Sarantopoulos, Konstantinos D.; Galor, Anat.

In: British Journal of Ophthalmology, Vol. 102, No. 5, 01.05.2018, p. 667-673.

Research output: Contribution to journalArticle

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AB - Aims The purpose of the study is to evaluate the relationship between dry eye (DE) and pain diagnoses in US veterans with and without traumatic brain injury (TBI). Methods Retrospective cohort study of veterans who were seen in the Veterans Administration Hospital (VA) between 1 January 2010 and 31 December 2014. Veterans were separated into two groups by the presence or absence of an International Classification of Diseases, Ninth Revision diagnosis of TBI and assessed for DE and other comorbidities. A dendrogram was used to investigate the linkage between TBI, DE, chronic pain and other comorbid conditions. Results Of the 3 265 894 veterans seen during the 5-year period, 3.97% carried a diagnosis of TBI. Veterans with TBI were more likely to have a diagnosis of DE compared with their counterparts without TBI (37.2% vs 29.1%, p<0.0005). The association was stronger between TBI and ocular pain (OR 3.08; 95% CI 3.03 to 3.13) compared with tear film dysfunction (OR 1.09; 95% CI 1.07 to 1.10). Those with TBI were also about twice as likely to have a diagnosis of chronic pain, headache, depression or post-traumatic stress disorder compared with their counterparts without TBI. Cluster analysis of TBI, DE and pain diagnoses of interest revealed that central pain syndrome, cluster headache, sicca syndrome, keratoconjunctivitis sicca and late effect of injury to the nervous system (as can be seen after TBI) were all closely clustered together. Conclusions DE and pain disorders occur at higher frequencies in patients with a diagnosis of TBI, suggesting a common underlying pathophysiology.

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