Referral to an ophthalmologist for definitive evaluation and treatment is warranted. 2 The affected pupil may be unreactive and mildly dilated. Patients often describe having a visual halo, and subtle conjunctival injection or corneal edema may be noted on examination. 22 Although classic narrow-angle glaucoma is easy to identify, the variability in presentation and the possible absence or minimization of visual changes can make diagnosis difficult. In persons with a shallow anterior chamber, the sudden increase in intraocular pressure may be precipitated by anything that dilates the pupil, such as anticholinergics, adrenergic stimulation, or dim lighting. Although the eye is usually inflamed, inflammation may be absent. 1, 20, 21 Persons with narrow-angle glaucoma classically present with headache or eye pain, vision changes, and nausea and vomiting. The annual incidence of narrow-angle glaucoma ranges from one to 30 per 1,000 persons, depending on age and ethnicity.
Narrow-angle glaucoma is one of the most common vision-threatening causes of acute pain in the quiet eye. Sinus tenderness, purulent nasal discharge “Rock hard” globe, elevated intraocular pressure Pupillary defect with swinging flashlight test Increased pain with movements such as bending, coughing, straining Increased pain with movements such as bending, coughing, straining, Valsalva maneuver nauseaĬonjunctival injection (may be palpebral only) “Clusters” of eye pain, rhinitis, facial sweating
The differential diagnosis of eye pain in the quiet eye is extensive, necessitating a systematic and thorough approach. Pain may also be referred from the sinuses or from neurologic conditions, such as trigeminal neuralgia, migraine and cluster headaches, and increased intracranial pressure. Other vascular conditions, such as carotid artery disease, thrombosis of the cavernous sinus, and transient ischemic attack or stroke, rarely cause eye pain but must be considered. Although most nonophthalmologic conditions that cause eye pain do not need immediate treatment, giant cell (temporal) arteritis requires urgent treatment with corticosteroids. Other migraine symptoms include throbbing pain, nausea, and sensitivity to light. Eye pain is a common side effect and symptom of a migraine or cluster headache. The pressure can lead to pain in one or both eyes as it builds up. Acute narrow-angle glaucoma is an emergent vision-threatening condition that requires immediate treatment and referral to an ophthalmologist. A sinus infection can lead to pressure behind the eyes. Pain in a quiet eye can be the first sign of a vision-threatening condition, a more benign ophthalmologic condition, or a nonophthalmologic condition. Although eye pain is often accompanied by redness or injection, pain can also occur with a quiet eye.
0 kommentar(er)
