Photophobia: shared pathophysiology underlying dry eye disease, migraine and traumatic brain injury leading to central neuroplasticity of the trigeminothalamic pathway
- 23 July 2020
- journal article
- review article
- Published by BMJ in British Journal of Ophthalmology
- Vol. 105 (6), 751-760
- https://doi.org/10.1136/bjophthalmol-2020-316417
Abstract
Background Photophobia is a potentially debilitating symptom often found in dry eye disease (DE), migraine and traumatic brain injury (TBI). Methods We conducted a review of the literature via a PubMed search of English language articles with a focus on how photophobia may relate to a shared pathophysiology across DE, migraine and TBI. Results DE, migraine and TBI are common conditions in the general population, are often comorbid, and share photophobia as a symptom. Across the three conditions, neural dysregulation of peripheral and central nervous system components is implicated in photophobia in various animal models and in humans. Enhanced activity of the neuropeptide calcitonin gene-related peptide (CGRP) is closely linked to photophobia. Current therapies for photophobia include glasses which shield the eyes from specific wavelengths, botulinum toxin, and inhibition of CGRP and its receptor. Many individuals have persistent photophobia despite the use of these therapies, and thus, development of new therapies is needed. Conclusions The presence of photophobia in DE, migraine and TBI suggests shared trigeminothalamic pathophysiologic mechanisms, as explained by central neuroplasticity and hypersensitivity mediated by neuropeptide CGRP. Treatment strategies which target neural pathways (ie, oral neuromodulators, transcutaneous nerve stimulation) should be considered in patients with persistent photophobia, specifically in individuals with DE whose symptoms are not controlled with traditional therapies.Keywords
Funding Information
- U.S. Department of Defense (GW190010)
- U.S. Department of Veterans Affairs (BX004893)
- National Eye Institute (R01EY026174)
- Center for Scientific Review (P30EY014801)
This publication has 122 references indexed in Scilit:
- Shedding Light on PhotophobiaJournal of Neuro-Ophthalmology, 2012
- Melanopsin signalling in mammalian iris and retinaNature, 2011
- Central sensitization: Implications for the diagnosis and treatment of painPain, 2011
- Thalamic sensitization transforms localized pain into widespread allodyniaAnnals of Neurology, 2010
- Induction of multiple photophobic behaviors in a transgenic mouse sensitized to CGRPNeuropharmacology, 2010
- A neural mechanism for exacerbation of headache by lightNature Neuroscience, 2010
- An fMRI case report of photophobia: Activation of the trigeminal nociceptive pathwayPain, 2009
- FL-41 Tint Improves Blink Frequency, Light Sensitivity, and Functional Limitations in Patients with Benign Essential BlepharospasmOphthalmology, 2009
- Calcitonin gene-related peptide stimulation of nitric oxide synthesis and release from trigeminal ganglion glial cellsBrain Research, 2008
- Central projections of melanopsin‐expressing retinal ganglion cells in the mouseJournal of Comparative Neurology, 2006