Survey highlights challenges in managing chronic ocular surface pain in US eye care clinics

Chronic ocular surface pain (COSP) is relatively common among eye care patients and closely linked to dry eye disease (DED), but current treatments are often unsatisfactory, according to a recent survey of US eye care providers.

“COSP aligns closely with definitions of systemic chronic pain and chronic pain syndromes, including neuropathic mechanisms,” said Kaleb Abbott, OD, MS, FAAO, FOWNS, a study author. “Yet eye care—both optometry and ophthalmology—has historically not framed it within these broader pain models. This neglect harms patients, leaves providers struggling to manage the condition effectively, and underestimates the true impact of COSP on quality of life.”

“Many patients live with chronic ocular surface pain, yet it is rarely recognized as a chronic pain condition,” Dr. Abbott added. “Too often, it is dismissed as ‘dry eye,’ which can sound relatively harmless, despite the significant burden it places on patients.”

The study, conducted in 2025 among an equal mix of optometrists (n = 50) and ophthalmologists (n = 50), assessed COSP prevalence, diagnostic approaches, treatment strategies, and provider satisfaction with current therapies.

Survey results indicated that COSP affects roughly one-third of patients seen by optometrists (33%) and ophthalmologists (29%). Among patients diagnosed with DED, nearly two-thirds (63%) also experienced COSP, highlighting the close but distinct relationship between the two conditions.

Common management strategies included over-the-counter artificial tears (97%), gels and ointments (90%), and hot compresses (86%), while prescription therapies for DED were used by 30–88% of respondents. Advanced interventions such as amniotic membranes, serum tears, intense pulsed light, and LipiFlow were less frequently employed. Satisfaction with treatment varied: providers were most satisfied with amniotic membranes and serum tears (64%), followed by device-based therapies (63%), prescription medications (40%), and OTC products or hot compresses (21%).

“Patients continue to experience chronic ocular pain, while providers report low satisfaction with available treatments,” Dr. Abbott said. “This underscores a major gap in effective therapies and highlights the urgent unmet need in this space. As awareness of COSP grows, I believe new therapeutic options will emerge in the coming years that are more specifically tailored to the needs of these patients.”