A Unifying Conceptual Framework of the World Organization of Dermophthalmology (WOD)
Background
Dry Eye Disease (DED) is traditionally defined as an ocular surface disorder characterized by tear-film instability, inflammation, and neurosensory abnormalities. However, the frequent mismatch between objective clinical findings and symptom severity suggests that surface pathology alone may not fully account for the disease experience. Contemporary pain neuroscience highlights the dynamic interaction between peripheral sensory input and central neural processing.
Objective
To propose a unifying conceptual framework in which dry eye is understood not only as an ocular surface disease, but also as a disorder of neuro-sensory regulation at the ocular interface.
Conceptual Basis
The ocular surface is among the most densely innervated structures in the human body. Sensory information is transmitted via the ophthalmic branch (V1) of the trigeminal nerve and integrated into central processing networks. Tear-film instability, Meibomian gland dysfunction, and chronic low-grade inflammation may increase peripheral sensory input. In selected patients, persistent peripheral stimulation may contribute to altered central processing and reduced sensory thresholds, thereby helping explain the sign–symptom mismatch and associations with chronic pain phenotypes.
The eyelid–ocular interface (OPHTHALMODERMA) functions as a regulatory unit influencing tear-film stability, barrier function, and inflammatory activity. Dysregulation of this interface may increase peripheral sensory load.
Useful Resources
Selected readings exploring the relationship between the eyes, headaches, and functional visual changes.