Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain

• Published in: The ocular surface Vol. 18; no. 4; pp. 814 - 820
• Main Authors: Ozmen, M. Cuneyt, Dieckmann, Gabriela, Cox, Stephanie M., Rashad, Ramy, Paracha, Rumzah, Sanayei, Nedda, Morkin, Melina I., Hamrah, Pedram
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2020
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic - therapeutic use; Dry eye disease; Eye Pain - drug therapy; Female; Humans; Male; Middle Aged; Neuralgia - drug therapy; Neuropathic corneal pain; Nortriptyline; Nortriptyline - therapeutic use; Quality of Life; Sensitization; Tricyclic antideppressant; Young Adult; Nortriptyline; Sensitization; Neuropathic corneal pain; Dry eye disease; Tricyclic antideppressant
• ISSN: 1542-0124; 1937-5913
• DOI: 10.1016/j.jtos.2020.08.006

Neuropathic corneal pain (NCP) is a recently acknowledged disease entity. However, there is no consensus in potential treatment strategies, particularly in patients with a centralized component of pain. This study aims to assess the efficacy and tolerability of the tricyclic antidepressant, nortriptyline, among NCP patients.
Patients with clinically diagnosed NCP and a centralized component of pain, treated with oral nortriptyline, who had recorded pain scores as assessed by the ocular pain assessment survey at the first and last visit were included. Patients were excluded if they had any other ocular pathology that might result in pain or had less than 4 weeks of nortriptyline use. Demographics, time between visits, concomitant medications, systemic and ocular co-morbidities, duration of NCP, side effects, ocular pain scores, and quality of life (QoL) assessment were recorded.
Thirty patients with a mean age of 53.1 ± 18.5 were included. Male to female ratio was 8:22. Mean ocular pain in the past 24 h improved from 5.7 ± 2.1 to 3.6 ± 2.1 after 10.5 ± 9.1 months (p < 0.0001). Twelve patients (40.0%) had equal to or more than 50% improvement, 6 patients (20.0%) had 30–49% improvement, 6 patients (20.0%) had 1–29% improvement, 4 patients (13.3%) did not improve, while 2 patients (6.7%) reported increase in pain levels. Mean QoL improved from 6.0 ± 2.5 to 4.3 ± 2.4 (p = 0.019). Eight patients (26.6%) discontinued treatment due to persistent side effects, despite improvement by 22.4%.
Nortriptyline was effective in relieving NCP symptoms in patients with centralized component and insufficient response to other systemic and topical therapies who tolerated the drug for at least 4 weeks. Nortriptyline may be used in the management of patients with NCP.