AAO 2026: Rethinking dry eye as a spectrum of ocular pain

Patients who say their eyes feel dry, gritty, or burning are among the most common in ophthalmology, and treating them well requires looking beyond a single dry eye diagnosis, according to Anat Galor, MD, MSPH, a professor of ophthalmology at Bascom Palmer Eye Institute and a staff physician at the Miami VA. At the American Academy of Ophthalmology (AAO) 2026 Annual Meeting in New Orleans, Louisiana, Galor spoke with Ophthalmology Times about ocular pain in everyday practice, emerging diagnostic tools, and treatment.

Why should dry eye be subtyped?

“The eyes are not an organ [that is] supposed to be felt,” Galor said. She compares the eyes to a canary in a coal mine, signaling that something may be wrong in the environment, the eye, or the body. Because the eyes can express discomfort in only a few ways, clinicians need to subtype dry eye into units that determine what each patient needs.

Basic tools are enough to start: a questionnaire, a finger to test for cutaneous allodynia, a cotton swab or dental floss to test corneal sensitivity, and topical anesthetic. Better biomarkers are still needed, she said. In vivo confocal microscopy can reveal hidden inflammation and nerve abnormalities, and research is exploring whether imaging signatures could help determine the cause of pain.

When should pain medication be considered?

Clinicians should first treat what they can see, such as inflammation with short-term corticosteroids or long-term cyclosporine, or allergy. If the nerves appear abnormal, topical neuromodulation may help peripheral nerve pain, but central pain requires oral neuromodulation. “Opioids should not be used for the management of chronic eye pain,” Galor said, noting that oral neuromodulators instead aim to change nerve function and reset the system.

Her advice to colleagues: “Don’t shy away from it. It is such a fun field.” Patients often cycle through medications and physicians, she said, and approaching each case as a detective can make a meaningful difference.

Galor discusses how to evaluate ocular pain and her approach to targeted treatment in part 1 of this interview.

For more from the meeting, visit Ophthalmology Times’ AAO 2026 coverage.