Eye Pain
Eye Pain: Excerpt from Field Guide to Bedside Diagnosis
Differential Overview
❑ Conjunctivitis
❑ Corneal abrasion
❑ Foreign body
❑ Sinusitis
❑ Migraine
❑ Acute glaucoma
❑ Orbital cellulitis
❑ Zoster prodrome
❑ Orbital fracture
❑ Keratitis
❑ Scleritis
❑ Iritis
❑ Optic neuritis
❑ Temporal arteritis
Diagnostic Approach
A foreign body sensation occurs with a foreign body, corneal abrasion, or keratoconjunctivitis sicca. Itching is associated with allergic and vernal conjunctivitis. Photophobia occurs with iritis and herpes simplex keratitis. Deep pain suggests acute glaucoma or posterior scleritis. Pain on eye movement is found with optic neuritis, sinusitis, and influenza.
Clinical Findings
Conjunctivitis There is a mild burning, grittiness, and foreign body sensation, accompanied by conjunctival erythema and discharge.
Corneal abrasion There is a prominent foreign body sensation, reflex blinking, and lacrimation, and a denuded area visible with fluorescein or slit lamp.
Foreign body There is usually a well-localized sensation of something in the eye, with abundant tearing.
Sinusitis Pain centers over the maxillary or frontal sinuses or the bridge of the nose.
Migraine This condition is recognized by its stereotypic repetitive nature, visual aura/scotoma, and nausea.
Acute glaucoma Ocular aching radiates to the frontal and temporal regions. Visual acuity is decreased and halos appear around lights. The anterior chamber is shallow, visualized by illumination with tangential light, the globe is firm and tender, the pupil is midposition and fixed, and the cornea is hazy.
Orbital cellulitis Cellulitis presents in a toxic patient as a rapidly advancing periorbital inflammation with proptosis and diplopia.
Zoster prodrome Pain is perceived over the entire distribution of the ophthalmic division of the trigeminal nerve, with a neuritic quality (burning, numb, lancinating).
Orbital fracture The color will be purplish from the outset, not beefy red like a black eye. There may be a limitation in extraocular movements if an ocular muscle is entrapped. Bilateral black eyes suggest basilar skull fracture.
Keratitis There is a loss of corneal luster, and central defects are visible with fluorescein. Herpes simplex keratitis has a characteristic branching (dendritic) pattern on the corneal surface.
Scleritis Presenting with deep, dull pain and localized scleral redness, it is often associated with connective tissue disease.
Iritis There is a dull ache and photophobia. The pupil is irregular, the anterior chamber is cloudy, and the limbus surrounding the iris is injected.
Optic neuritis Neuritis begins with eye pain aggravated by movement and abnormal color vision with a central scotoma. The involved eye has an afferent pupillary defect (normal consensual but decreased direct light response). The optic disc may appear normal or similar to early papilledema except that retinal venous pulsations are present. Optic neuritis may be the presenting manifestation of multiple sclerosis in 10% to 15% of cases.
Temporal arteritis A tender, ropy temporal artery and jaw claudication in an elderly patient are important corroborative clues.
Book Source Details
- Book Title: Field Guide to Bedside Diagnosis
- Author(s): David S. Smith
- Year of Publication: 2007
- Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Field Guide to Bedside Diagnosis
Authors: David S. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 0-78178-165-5
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» Next page: Conjunctivitis (Handbook of Diseases)
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