Photophobia

Photophobia: Excerpt from Handbook of Signs & Symptoms (Third Edition)

A common symptom, photophobia is an abnormal sensitivity to light. In many patients, photophobia simply indicates increased eye sensitivity without underlying pathology. For example, it can stem from wearing contact lenses excessively or using poorly fitted lenses. However, in others, this symptom can result from a systemic disorder, an ocular disorder or trauma, or the use of certain drugs. (See Photophobia: Common causes and associated findings.)

History and physical examination

If the patient reports photophobia, find out when it began and how severe it is. Did it follow eye trauma, a chemical splash, or exposure to the rays of a sun lamp? If photophobia results from trauma, avoid manipulating the eyes. Ask the patient about eye pain and have him describe its location, duration, and intensity. Does he have a sensation of a foreign body in his eye? Does he have other signs and symptoms, such as increased tearing and vision changes?

Next, take the patient’s vital signs and assess his neurologic status. Assess visual activity, unless the cause is a chemical burn. Follow this with a careful eye examination, inspecting the eyes’external structures for abnormalities. Examine the conjunctiva and sclera, noting their color. Characterize the amount and consistency of any discharge. Then check pupillary reaction to light. Evaluate extraocular muscle function by testing the six cardinal fields of gaze, and test visual acuity in both eyes.

During your assessment, keep in mind that although photophobia can accompany life-threatening meningitis, it isn’t a cardinal sign of meningeal irritation.

Medical causes

Burns

With a chemical burn, photophobia and eye pain may be accompanied by erythema and blistering on the face and lids, miosis, diffuse conjunctival injection, and corneal changes. The patient experiences blurred vision and may be unable to keep his eyes open. With an ultraviolet radiation burn, photophobia occurs with moderate to severe eye pain. These symptoms develop about 12 hours after exposure to the rays of a welding arc or sun lamp.

Conjunctivitis

When conjunctivitis affects the cornea, it causes photophobia. Other common findings include conjunctival injection, increased tearing, a foreign-body sensation, a feeling of fullness around the eyes, and eye pain, burning, and itching. Allergic conjunctivitis is distinguished by a stringy eye discharge and milky red injection. Bacterial conjunctivitis tends to cause a copious, mucopurulent, flaky eye discharge that may make the eyelids stick together as well as brilliant red conjunctiva. Fungal conjunctivitis produces a thick, purulent discharge, extreme redness, and crusting, sticky eyelids. Viral conjunctivitis causes copious tearing with little discharge as well as enlargement of the preauricular lymph nodes.

Corneal abrasion

A common finding with corneal abrasion, photophobia is usually accompanied by excessive tearing, conjunctival injection, visible corneal damage, and a foreign-body sensation in the eye. Blurred vision and eye pain may also occur.

Corneal ulcer

A corneal ulcer is a vision-threatening disorder that causes severe photophobia and eye pain aggravated by blinking. Impaired visual acuity may accompany blurring, eye discharge, and sticky eyelids. Conjunctival injection may occur even though the cornea appears white and opaque. A bacterial ulcer may also cause an irregularly shaped corneal ulcer and unilateral pupillary constriction. A fungal ulcer may be surrounded by progressively clearer rings.

Iritis (acute)

Severe photophobia may result from acute iritis, along with marked conjunctival injection, moderate to severe eye pain, and blurred vision. The pupil may be constricted and may respond poorly to light.

Keratitis (interstitial)

Keratitis is a corneal inflammation that causes photophobia, eye pain, blurred vision, dramatic conjunctival injection, and grayish pink corneas.

Meningitis (acute bacterial)

A common symptom of meningitis, photophobia may occur with other signs of meningeal irritation, such as nuchal rigidity, hyperreflexia, and opisthotonos. Brudzinski’s and Kernig’s signs can be elicited. A fever, an early finding, may be accompanied by chills. Related signs and symptoms may include a headache, vomiting, ocular palsies, facial weakness, pupillary abnormalities, and hearing loss. With severe meningitis, seizures may occur along with stupor progressing to coma.

Migraine headache

Photophobia and noise sensitivity are prominent features of a common migraine. Typically severe, this aching or throbbing headache may also cause fatigue, blurred vision, nausea, and vomiting.

Uveitis

Anterior and posterior uveitis can cause photophobia. Typically, anterior uveitis also produces moderate to severe eye pain, severe conjunctival injection, and a small, nonreactive pupil. Posterior uveitis develops slowly, causing visual floaters, eye pain, pupil distortion, conjunctival injection, and blurred vision.

Other causes

Drugs

Mydriatics — such as phenylephrine, atropine, scopolamine, cyclopentolate, and tropicamide — can cause photophobia due to ocular dilation. Amphetamines, cocaine, and ophthalmic antifungals — such as trifluridine, vidarabine, and idoxuridine — can also cause photophobia.

Special considerations

Promote the patient’s comfort by darkening the room and telling him to close both eyes. If photophobia persists at home, suggest that he wear dark glasses. Prepare the patient for diagnostic tests, such as corneal scraping and slit-lamp examination.

Pediatric pointers

Suspect photophobia in any child who squints, rubs his eyes frequently, or wears sunglasses indoors and outside. Congenital disorders, such as albinism, and childhood diseases, such as measles and rubella, can cause photophobia.

Pictures

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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