Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain

  • Serkan Ozen
  • Murat Atabey Ozer
  • Mehmet Orçun Akdemir
Cornea

Abstract

Purpose

This study aims to understand the effect of vitamin B12 deficiency on neuropathic ocular pain (NOP) and symptoms in patients with dry eye disease (DED).

Methods

Patients with severe DED (without receiving topical artificial tears treatment) and ocular pain were enrolled (n = 90). Patients with severe DED and vitamin B12 deficiency (group 1, n = 45) received parenteral vitamin B12 supplement + topical treatment (artificial tears treatment + cyclosporine), and patients with severe DED and normal serum vitamin B12 level (group 2, n = 45) received only topical treatment (artificial tears treatment + cyclosporine). Patients were evaluated by the ocular surface disease index (OSDI) questionnaire, 3rd question (have you experienced painful or sore eyes during last week?) score of OSDI as a pain determiner and pain frequency measure), tear break up time (TBUT), and Schirmer’s type 1 test. We compared the groups’ OSDI, TBUT, and Schirmer’s test recordings at the first visit and after 12 weeks retrospectively.

Results

The OSDI score, 3rd OSDI question score, TBUT, and Schirmer’s test results improved after 12 weeks (p < 0.001 for each group). The mean vitamin B12 level at enrollment was 144.24 ±43.36 pg/ml in group 1 and 417.53 ±87.22 pg/ml in group 2. The mean vitamin B12 level in group 1 reached to 450 ±60.563 pg/ml after 12 weeks of treatment. The mean score changes between the groups were not statistically significant; however, the decrease in the OSDI questionnaire score (-30.80 ±5.24) and 3rd OSDI question score (-2.82 ±0.53) were remarkable in group 1 (Table 2). The mean TBUT increase was +7.98 ±2.90 s and Schirmer’s test result increase was +12.16 ±2.01 mm in group 1. The mean TBUT increase was +6.18 ±1.49 s and Schirmer’s test result increase was +6.71 ±1.47 mm in group 2.

Conclusions

These findings indicate that vitamin B12 deficiency is related with NOP. It may be important to consider measuring the serum vitamin B12 level in patients with severe DED presenting with resistant ocular pain despite taking topical treatment.

Keywords

Vitamin B12 Neuropathic ocular pain Dry eye disease 

References

  1. 1.
    Javadi MA, Feizi S (2011) Dry eye syndrome. J Ophthalmic Vis Res 6(3):192–198PubMedPubMedCentralGoogle Scholar
  2. 2.
    Galor A, Zheng DD, Arheart KL et al (2012) Dry eye medication use and expenditures: data from the medical expenditure panel survey 2001 to 2006. Cornea 31(12):1403–1407CrossRefPubMedGoogle Scholar
  3. 3.
    Pergolizzi J, Ahlbeck K, Aldington D et al (2013) The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Curr Med Res Opin 29(9):1127–1135CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Belmonte C, Acosta MC, Merayo-Lloves J et al (2015) What causes eye pain? Curr Ophthalmol Rep 3:111–121CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Xu G, Lv ZW, Xu GX et al (2014) Thiamine, cobalamin, locally injected alone or combination for herpetic itching: a single-center randomized controlled trial. Clin J Pain 30:269–278CrossRefPubMedGoogle Scholar
  6. 6.
    Talaei A, Siavash M, Majidi H et al (2009) Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 60(suppl 5):71–76CrossRefPubMedGoogle Scholar
  7. 7.
    Ponce-Monter HA, Ortiz MI, Garza-Hernandez AF et al (2012) Effect of diclofenac with B vitamins on the treatment of acute pain originated by lower-limb fracture and surgery. Pain Res Treat 2012:104782PubMedGoogle Scholar
  8. 8.
    Okumus M, Ceceli E, Tuncay F et al (2010) The relationship between serum trace elements, vitamin B12, folic acid and clinical parameters in patients with myofascial pain syndrome. J Back Musculoskelet Rehabil 23:187–191CrossRefPubMedGoogle Scholar
  9. 9.
    Al-MaskariM WMI, Ali A et al (2012) Folate and vitamin B12 deficiency and hyperhomocysteinemia promote oxidative stress in adult type 2 diabetes. Nutrition 28(7–8):e23–e26CrossRefGoogle Scholar
  10. 10.
    Romano MR, Biagioni F, Carrizzo A et al (2014) Effects of vitamin B12 on the corneal nerve regeneration in rats. Exp Eye Res 120:109–117CrossRefPubMedGoogle Scholar
  11. 11.
    Rosenthal P, Baran I, Jacobs DS (2009) Corneal pain without stain: is it real? Ocul Surf 7(1):28–40CrossRefPubMedGoogle Scholar
  12. 12.
    Rosenthal P, Borsook D (2012) The corneal pain system. part I: the missing piece of the dry eye puzzle. Ocul Surf 10(1):2–14CrossRefPubMedGoogle Scholar
  13. 13.
    Macri A, Scanarotti C, Bassi AM et al (2015) Evaluation of oxidative stres levels in the conjunctival epithelium of patients with or without dry eye, and dry eye patients treated with preservative-free hyaluronic acid 0.15% and vitamin B12 eye drops. Graefes Arch Clin Exp Ophthalmol 253:425–430CrossRefPubMedGoogle Scholar
  14. 14.
    Shetty R, Deshpande K, Ghosh A et al (2015) Management of ocular neuropathic pain with vitamin B12 supplements: a case report. Cornea 34(10):1324–1325CrossRefPubMedGoogle Scholar
  15. 15.
    Schiffman RM, Christianson MD, Jacobsen G et al (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621CrossRefPubMedGoogle Scholar
  16. 16.
    Kalangara JP, Galor A, Levitt RC et al (2016) Burning eye syndrome: do neuropathic pain mechanisms underlie chronic dry eye? Pain Med 17(4):746–755PubMedGoogle Scholar
  17. 17.
    Galor A, Batawi H, Felix ER et al (2016) Incomplete response to artificial tears is associated with features of neuropathic ocular pain. Br J Ophthalmol 100(6):745–749CrossRefPubMedGoogle Scholar
  18. 18.
    Galor A, Zlotcavitch L, Walter SD (2015) Dry eye symptom severity and persistence are associated with symptoms of neuropathic pain. Br J Ophthalmol 99(5):665–668CrossRefPubMedGoogle Scholar
  19. 19.
    Zhang M, Han W, Hu S (2013) Methylcobalamin: a potential vitamin of pain killer. Neural Plast 2013:424651CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Serkan Ozen
    • 1
  • Murat Atabey Ozer
    • 1
  • Mehmet Orçun Akdemir
    • 2
  1. 1.Section of Surgical Sciences, Department of Ophthalmology, Faculty of MedicineGiresun UniversityDebboyTurkey
  2. 2.Section of Surgical Sciences, Department of Ophthalmology, Faculty of MedicineBülent Ecevit University ZonguldakZonguldakTurkey

Personalised recommendations