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Participants were recruited at an ophthalmology clinic at the Miami Veterans Affairs Hospital and evaluated for a diagnosis of ME\/CFS, or symptoms of ME\/CFS (intermediate fatigue, IF) using the Canadian Consensus criteria. Ocular symptoms were assessed via standardised questionnaires and signs via comprehensive slit lamp examination. Inflammatory blood markers were analysed and compared across groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age was 55.1\u2009\u00b1\u20094.7\u2009years, 88.7% identified as male, 58.1% as White, and 39.5% as Hispanic. Ocular symptoms were more severe in the ME\/CFS (<jats:italic>n<\/jats:italic>\u2009=\u200932) and IF (<jats:italic>n<\/jats:italic>\u2009=\u200948) groups compared to controls (<jats:italic>n<\/jats:italic>\u2009=\u200944) across dry eye (DE; Ocular Surface Disease Index [OSDI]: 48.9\u2009\u00b1\u200922.3 vs. 38.8\u2009\u00b1\u200923.3 vs. 19.1\u2009\u00b1 17.8, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; 5 item Dry Eye Questionnaire [DEQ\u20105]: 10.8\u2009\u00b1\u20093.9 vs. 10.0\u2009\u00b1\u20094.6 vs. 6.6\u2009\u00b1\u20094.2, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and pain\u2010specific questionnaires (Numerical Rating Scale 1\u201010 [NRS] right now: 2.4\u2009\u00b1\u20092.8 vs. 2.4\u2009\u00b1\u20092.9 vs 0.9\u2009\u00b1\u20091.5; <jats:italic>p<\/jats:italic>\u2009=\u20090.007; Neuropathic Pain Symptom Inventory modified for the Eye [NPSI\u2010E]: 23.0\u2009\u00b1\u200918.6 vs. 19.8\u2009\u00b1\u200919.1 vs. 6.5\u2009\u00b1\u20099.0, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Ocular surface parameters and blood markers of inflammation were generally similar across groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Individuals with ME\/CFS report increased ocular pain but similar DE signs, suggesting that mechanisms beyond the ocular surface contribute to symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ceo.14313","type":"journal-article","created":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T06:51:24Z","timestamp":1699858284000},"page":"10-21","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dry eye symptoms and signs in United States Gulf War era veterans with myalgic encephalomyelitis\/chronic fatigue syndrome"],"prefix":"10.1111","volume":"52","author":[{"given":"Victor","family":"Sanchez","sequence":"first","affiliation":[{"name":"New York University Grossman School of Medicine  New York New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin K.","family":"Kim","sequence":"additional","affiliation":[{"name":"University of Miami Miller School of Medicine  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elyana V. T.","family":"Locatelli","sequence":"additional","affiliation":[{"name":"Ophthalmology, Miami Veterans Affairs Medical Center  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam K.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Rice University  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Ophthalmology, Miami Veterans Affairs Medical Center  Miami Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Aenlle","sequence":"additional","affiliation":[{"name":"Ophthalmology, Miami Veterans Affairs Medical Center  Miami Florida USA"},{"name":"Institute for Neuro\u2010Immune Medicine, K. 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