SAN FRANCISCO — The tricyclic antidepressant nortriptyline was “relatively safe” and significantly improved symptoms of neuropathic corneal pain, according to researchers at the American Academy of Ophthalmology annual meeting.
The findings suggested that nortriptyline is a “good candidate to be a first-line treatment” for neuropathic corneal pain with a centralized component, Mehmet C. Ozmen, MD, FICO, postdoctoral clinical research fellow at Tufts Medical Center, Tufts University School of Medicine, and associate professor of ophthalmology at Gazi University School of Medicine in Turkey, and colleagues reported.
“Neuropathic corneal pain is a recently acknowledged disease entity,” Ozmen said during a presentation. “It is characterized by pain sensation that may occur without apparent ocular surface disease.”
Nortriptyline has previously shown promise against neuropathic pain in other areas of the body, according to the researchers. However, data on its use in neuropathic corneal pain are limited.
Ozmen and colleagues assessed the efficacy and tolerability of nortriptyline among 54 patients (mean age, 52 years) who had neuropathic corneal pain with central sensitization components and whose symptoms persisted despite previous treatment with anesthetic drops. The final analysis included 32 patients with documented pretreatment and posttreatment pain scores who received nortriptyline for at least 4 weeks. The mean duration of neuropathic corneal pain was 16 months prior to nortriptyline treatment. On average, patients remained on treatment for about 10 months.
Patients’ Novel Ocular Pain Assessment Survey (OPAS) scores improved 33% (5.59 to 3.75), according to the researchers. Quality-of-life OPAS scores also improved from 6 to 4.3.
Additional results showed that 12 patients had more than 50% improvement in symptoms, whereas 14 patients had less than 30% improvement.
Approximately 25% of patients discontinued nortriptyline treatment due to “mild” adverse events; however, these patients still had a 22% improvement in pain, Ozmen reported.
“So, in conclusion, nortriptyline is a relatively safe and effective adjunct treatment for pain symptoms in neuropathic corneal pain,” he said. “Of course, randomized, double-blind studies are needed to prove this efficacy.” – by Stephanie Viguers
Reference: Ozmen MC, et al. Efficacy and tolerability of nortriptyline in the management of neuropathic corneal pain. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Ozmen reports receiving grant and research support from The Scientific and Technological Research Council of Turkey and Tufts Medical Center.