Abstract
Ocular pain is most commonly associated with redness and inflammation; however, eye pain can also occur in the absence of grossly visible pathology. Pain in the quiet eye can be the first sign of a number of threatening conditions. Many of these conditions such as intermittent angle closure glaucoma, carotid artery dissection, idiopathic intracranial hypertension, and giant cell arteritis can lead to permanent vision loss or blindness. In this review, ocular history and examination techniques are summarized. The article also reviews pertinent ocular, orbital, referred, and other causes of eye pain in the quiet eye. The neurologist and headache specialist should recognize when consultation with an ophthalmologist is necessary.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Harooni H, Golnik KC, Geddie B, et al.: Diagnostic yield for neuroimaging in patients with unilateral eye or facial pain. Can J Ophthalmol 2005, 40(6):759–63.
Abelson MB, Ousler GW, Maffei C: Dry eye in 2008. Curr Opin Ophthalmol 2009, 20:282–6.
Schindler KS, Sankar PS, Volpe NJ, et al.: Intermittent headaches as the presenting sign of subacute angle closure glaucoma. Neurology 2005, 65:757–8.
Galor A, Thorne JE: Scleritis and peripheral ulcerative keratitis. Rheum Dis Clin North Am. 2007;33:835–54.
Paraja JA, Sanchez-del-Rio M: Primary trochlear headache and other trochlear painful disorders. Curr Pain Headache Rep. 2006;10:316–20.
Yanguela J, Sanchez-del-Rio M, Bueno A, et al.: Primary trochlear headache; a new cephalgia generated and modulated in the trochlear region. Neurology 2004, 62:1134–40.
• Mughal M, Longmuir R: Current pharmacologic testing for Horner syndrome. Curr Neurol Neurosci Rep 2009, 9:384–9. Traditionally, testing for Horner syndrome is done using 10% cocaine. This is a difficult drug to obtain and store for physicians because of its classification as a controlled substance. The authors conclude that apraclonidine is a new and dependable diagnostic test for Horner syndrome; however, they do raise concern about the number of false-negative tests and the safety of apraclonidine testing in children.
Bartsch T, Goadsby PJ: Stimulation of the greater occipital nerve induces increased central excitability of dural afferent input. Brain 2002, 125(7):1496–1509.
Evers S: Status on the use of botulinum toxin for headache disorders. Curr opin neurol 2006, 19:310–15.
Obermann M, Katsarava Z: Update on trigeminal neuralgia. Expert Rev Neurother. 2009, 9:323–9.
Cheng TM, Cascino TL, Onofrio BM: Comprehensive study of diagnosis and treatment of trigeminal neuralgia secondary to tumors. Neurology 1993, 43(11):298–302.
Gronseth G, Crucus G, Alksne J, et al.: Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the quality standards subcommittee of the american academy of Neurology and the European federation of neurological societies. Neurology 2008, 71:1183–90
Evans RW, Pareja JA: Expert opinion: supraorbital neuralgia. Headache 2009, 49:278–81.
Sjaastad O, Stolt-Nielsen A, Pareja JA, et al.: Supraorbital neuralgia. The clinical manifestations and a possible therapeutic approach. Headache 1999, 39:204–12.
Pareja JA, Sjaastad O: SUNCT syndrome in the female. Headache 1994, 34:217–20.
Williams MH, Broadley SA: SUNCT and SUNA: Clinical features and medical treatment. Journal of Clinical Neuroscience 2008, 15:526–34.
Matharu M, Goadsby P: Cluster headache—update on a common neurological problem. Pract Neurol 2001, 1: 42–9.
Cittadini E, Matharu MS, Goadsby PJ: Paroxysmal hemicrania: a prospective clinical study of 31 cases. Brain 2008, 131:1142–55.
Matharu MS, Boes CJ, Goadsby PJ: Management of trigeminal autonomic cephalgias and hemicrania continua. Drugs 2003, 63:1637–77.
Goadsby PJ, Cohen AS, Matharu MS: Trigeminal autonomic cephalgias: diagnosis and treatment. Curr Neurol Neursci Rep 2007, 7:117–25.
Favier I, van Vliet JA, Roon KI et al.: Trigeminal autonomic cephalgias dues to structural lesions: a review of 31 cases. Arch Neurol 2007, 64:25–31.
Dafer RM, Jay WM: Headache and the eye. Curr Opin Ophthalmol 2009, 20:520–24.
Acknowledgment
M.S. Lee has received an unrestricted grant from Research to Prevent Blindness, New York, NY.
Disclosure
Conflicts of interest: A.L. Ringeisen: none; A.R. Harrison: is a consultant for Merz Pharmaceuticals; M.S. Lee: none.
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Ringeisen, A.L., Harrison, A.R. & Lee, M.S. Ocular and Orbital Pain for the Headache Specialist. Curr Neurol Neurosci Rep 11, 156–163 (2011). https://doi.org/10.1007/s11910-010-0167-6
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DOI: https://doi.org/10.1007/s11910-010-0167-6
Keywords
- Ocular pain
- Orbital pain
- Eye pain
- Quiet eye
- Headache
- Orbit
- Migraine
- Ocular surface disease
- Eyestrain
- Asthenopia
- Intermittent angle closure glaucoma
- Posterior scleritis
- Primary trochlear headache
- Trochleitis
- Carotid artery dissection
- Cervicogenic eye pain
- Supraorbital neuralgia
- Trigeminal neuralgia
- Trigeminal autonomic cephalgia
- Cluster headache
- SUNCT syndrome
- Hemicrania continua
- Paroxysmal hemicrania
- Giant cell arteritis
- Idiopathic intracranial hypertension