The role of instrumental research methods in the diagnosis of burning eye syndrome

Background. The polyetiology of dry eye syndrome requires a whole range of diagnostic measures. In turn, to verify the subtype of dry eye syndrome – burning eye syndrome – it is necessary to record characteristic changes in nerve fibers and the lipid layer of the tear film. This can be done using such methods as laser scanning confocal microscopy, thiascopy and tear osmolarmetry.

Aim. To determine the role of instrumental research methods in the diagnosis of burning eye syndrome.

Materials and methods. 31 patients (14 men, 17 women) aged 18–45 years were examined, the average age of the subjects was 31 ± 3 years. The patients complained of dryness, burning, discomfort during visual work, and eye pain. The control group was formed from 28 healthy volunteers matched for gender and age. The exclusion criteria from the study were: clinical signs of blepharitis and dysfunction of the meibomian glands, rheumatological (rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, scleroderma) and oncological diseases. In addition to a functional ophthalmological examination, all patients underwent laser scanning confocal microscopy of the cornea on an HRT III device with a Cornea Rostock corneal module to assess the condition of the epithelium and nerve fibers of the cornea. Thiascopy was used to assess the lipid layer of the tear film.

Results. In the group of patients with burning eye syndrome, the greatest changes in the structure of the nerve fiber were statistically reliably recorded, in comparison with patients with dry eye syndrome and volunteers. The tear osmolarity indicators were close to the results of the control group, no statistically significant difference was recorded between them. According to the results of tiascopy, changes in the lipid layer of the tear film were pronounced: zones with a thickness of more than 0.5 μm and 0.27–0.5 μm averaged 0.04 % and 2.2 %, respectively.

Conclusion. The implementation of specialized instrumental methods and the combined assessment of their results play a decisive role in the diagnosis of burning eye syndrome, which allows for the prescription of appropriate treatment.

1. Kalangara J. P., Galor A., Levitt R. C. et al. Burning eye syndrome: Do neuropathic pain mechanisms underlie chronic dry eye? Pain Med 2016;17(4):746–55. DOI: 10.1093/pm/pnv070

2. Galor A., Moein H. R., Lee C. et al. Neuropathic pain and dry eye. Ocul Surf 2018;16:31–44. DOI: 10.1016/j.jtos.2017.10.001

3. Brzheskiy V. V. Modern possibilities of pathogenetically oriented therapy for dry eye syndrome. Vestnik oftalmologii = Bulletin of Ophthalmology 2023;139(2):95–103. (In Russ.). DOI: 10.17116/oftalma202313902195

4. Danilov A. B. Neuropathic pain. Klinicheskaya gerontologiya = Clinical Gerontology 2007;13(2):27–36. (In Russ.).

5. Egorova G. B., Novikov I. A., Mitichkina T. S. Perfection and assessment of the possibilities of the method of tiascopy. Vestnik oftalmologii = Bulletin of Ophthalmology 2011;127(6):35–40. (In Russ.).

6. Kintyukhina N. P., Safonova T. N., Gladkova O. V. Application of laser scanning confocal microscopy of the eyelids in intraductal probing of the meibomian glands. Sovremennye tekhnologii v oftalmologii = Modern Technologies in Ophthalmology 2017;4:112–14. (In Russ.).

7. Avetisov S. E., Surnina Z. V. Confocal microscopy of the corneal nerve fibers. Vestnik oftalmologii = Bulletin of Ophthalmology 2023;139(3–2):38–45. (In Russ.) DOI: 10.17116/oftalma202313903238

8. Mastropasqua L., Nubile M., Lanzini M. et al. Epithelial dendritic cell distribution in normal and inflamed human cornea: In vivo confocal microscopy study. Am J Ophthalmol 2006;142(5):736–44. DOI: 10.1016/j.ajo.2006.06.057

9. Nicola R., Labbe A., Amar N. et al. In vivo confocal microscopy and ocular surface diseases: Anatomical-clinical correlation. J Fr Ophtalmol 2005;28(7):691–8. DOI: 10.1016/s1542-0124(12)70353-1

10. Craig J. P., Nelson J. D., Azar D. T. et al. TFOS DEWS II report executive summary. Ocul Surf 2017;15(4):802–12. DOI: 10.1016/j.jtos.2017.08.003

11. Stettner M., Hinrichs L., Guthoff R. et al. Corneal confocal microscopy in chronic inflammatory demyelinating polyneuropathy. Ann Clin Transl Neurol 2015;3(2):88–100. DOI: 10.1002/acn3.275

12. Safonova T. N., Surnina Z. V., Medvedeva E. S. Laser confocal microscopy of corneal nerve fibers in patients with burning eye syndrome and dry eye disease. Nervno-myshechnye bolezni = Neuromuscular Diseases 2024;14(1):34–41. (In Russ.). DOI: 10.17650/2222-8721-2024-14-1-34-41

13. Safonova T. N., Medvedeva E. S. Dysfunction of the meibomian glands in patients with diabetes mellitus. Diabetes Mellitus 2022; 25(2):186–91. (In Russ.). DOI: 10.14341/DM12798

14. Safonova T. N., Medvedeva E. S. Pharmacological correction of burning eye syndrome. Vestnik oftalmologii = Bulletin of Ophthalmology 2025;141(2):51–8. (In Russ.). DOI: 10.17116/oftalma202514102151