Skip to main content

Advertisement

SpringerLink
Log in

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

  • Cornea
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Javadi MA, Feizi S (2011) Dry eye syndrome. J Ophthalmic Vis Res 6(3):192–198

    PubMed  PubMed Central  Google Scholar 

  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):1403–1407

    Article  PubMed  Google Scholar 

  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):1127–1135

    Article  PubMed  PubMed Central  Google Scholar 

  4. Belmonte C, Acosta MC, Merayo-Lloves J et al (2015) What causes eye pain? Curr Ophthalmol Rep 3:111–121

    Article  PubMed  PubMed Central  Google Scholar 

  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 30:269–278

    Article  PubMed  Google Scholar 

  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):71–76

    Article  CAS  PubMed  Google Scholar 

  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 2012:104782

    PubMed  Google Scholar 

  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 23:187–191

    Article  CAS  PubMed  Google Scholar 

  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–e26

    Article  Google Scholar 

  10. Romano MR, Biagioni F, Carrizzo A et al (2014) Effects of vitamin B12 on the corneal nerve regeneration in rats. Exp Eye Res 120:109–117

    Article  CAS  PubMed  Google Scholar 

  11. Rosenthal P, Baran I, Jacobs DS (2009) Corneal pain without stain: is it real? Ocul Surf 7(1):28–40

    Article  PubMed  Google Scholar 

  12. Rosenthal P, Borsook D (2012) The corneal pain system. part I: the missing piece of the dry eye puzzle. Ocul Surf 10(1):2–14

    Article  PubMed  Google Scholar 

  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 253:425–430

    Article  CAS  PubMed  Google Scholar 

  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):1324–1325

    Article  PubMed  Google Scholar 

  15. Schiffman RM, Christianson MD, Jacobsen G et al (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615–621

    Article  CAS  PubMed  Google Scholar 

  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):746–755

    PubMed  Google Scholar 

  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):745–749

    Article  PubMed  Google Scholar 

  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):665–668

    Article  PubMed  Google Scholar 

  19. Zhang M, Han W, Hu S (2013) Methylcobalamin: a potential vitamin of pain killer. Neural Plast 2013:424651

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Surgical Sciences, Department of Ophthalmology, Faculty of Medicine, Giresun University, Debboy, 28100, Giresun, Turkey

    Serkan Ozen & Murat Atabey Ozer

  2. Section of Surgical Sciences, Department of Ophthalmology, Faculty of Medicine, Bülent Ecevit University Zonguldak, 67600, Zonguldak, Turkey

    Mehmet Orçun Akdemir

Authors
  1. Serkan Ozen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murat Atabey Ozer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Orçun Akdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Serkan Ozen.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozen, S., Ozer, M.A. & Akdemir, M.O. Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain. Graefes Arch Clin Exp Ophthalmol 255, 1173–1177 (2017). https://doi.org/10.1007/s00417-017-3632-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-017-3632-y

Keywords

Search

Navigation