There’s currently no consensus on treatment strategies for neuropathic corneal pain (NCP), a newly acknowledged diseased entity; however, a recent study offered one avenue of pain relief: an antidepressant. The research team tested the efficacy and tolerability of a tricyclic antidepressant, nortriptyline, for patients with NCP.

The study included 30 patients with clinically diagnosed NCP, a centralized component of pain and who had an insufficient response to other systemic and topical treatment. All patient were treated with oral nortriptyline for at least four weeks. Those with other pathology that might contribute to pain were excluded from the study.

Thirty patients (mean age 53.1±18.5 years; male to female ratio 8:22) recorded their pain scores in an ocular pain assessment survey during their first and last visit. The researchers also collected information on demographics, time between visits, concomitant medications, comorbidities, duration of NCP, side effects and quality of life.

The ocular pain assessments showed that mean ocular pain in the past 24 hours improved from a score of 5.7±2.1 to 3.6±2.1 after 10.5±9.1 months of nortriptyline use. Most patients experienced some level of improvement, with only four reporting no improvement and two reporting increased pain levels. The average quality of life scores improved across the board. Eight patients discontinued treatment to due persistent side effects, despite an improvement of 22.4%.

The researchers concluded that nortriptyline may be used to manage patients with NCP. Nortriptyline was effective in relieving NCP symptoms in patients with a centralized component of pain and an insufficient response to other systemic and topical therapies who tolerated the drug for at least four weeks.

Ozmen MC, Dieckmann G, Cox SM, et al. Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain. The Ocular Surface 2020;18:4:814-20.