Photophobia

Photophobia: Excerpt from In a Page: Signs and Symptoms

Photophobia is ocular pain or discomfort upon exposure to light. It may be a symptom of a primary ocular disorder or underlying central nervous system disorder and should always be evaluated, unless a known etiology (e.g., migraine headache) is present.

Differential Diagnosis

• Corneal abrasion
• Conjunctivitis
  –Viral: Watery discharge; adenovirus most common, also herpes simplex
  –Allergic: Usually bilateral
  –Chemical: History of exposure
  –Bacterial (rare): Purulent discharge
• Migraine headache: Normal eye and neurologic exam, headache, phonophobia
• Idiopathic anterior uveitis/iritis (often associated with a triad of pain, photophobia, and blurred vision)
  –Ankylosing spondylitis
  –Reiter's syndrome
  –Inflammatory bowel disease
  –Psoriatic arthritis
  –Sarcoidosis
  –Infections (e.g., Lyme disease, herpes simplex/zoster, tuberculosis, syphilis)
  –Postoperative reactions
  • Meningitis/encephalitis
  • SAH
  • Influenza
  • Lightly pigmented eye
  • Mydriatic use
  • Keratoconjunctivitis sicca, or dry eye syndrome
  • Less common etiologies (“zebras”) include albinism, total color blindness, vitamin A deficiency, measles, posterior uveitis, congenital glaucoma, sinusitis, mononucleosis, influenza, Colorado tick fever, babesiosis, botulism, and acute viral hepatitis (A, B, or E)

  Workup and Diagnosis

  • History and physical examination
    –Focused history for exposure to foreign bodies (e.g., woodworking or other flying debris), allergens, exposure to others with URI and/or conjunctivitis, systemic symptoms (e.g., arthritis)
    –Physical exam should include a detailed neurologic exam, ocular exam (including dilated fundoscopic and slit-lamp exam if possible), eyelid eversion to rule out foreign bodies, fluorescein staining of the cornea to rule out abrasion, and intraocular pressure measurement
  • Head CT scan without contrast if subarachnoid hemorrhage is suspected
  • Lumbar puncture if subarachnoid hemorrhage or meningitis is suspected
  • CBC and/or blood cultures if suspect meningitis
  • Further workup is based on examination
    –If anterior uveitis is suspected, targeted testing may include CBC, ESR, ANA, ACE level (sarcoidosis), RPR (syphilis), PPD, chest X-ray (TB/sarcoidosis), Lyme titers, Chlamydia cultures (Reiter's syndrome), HLA-B27 assay, sacroiliac spine films (ankylosing spondylitis), and colonoscopy (inflammatory bowel disease)
    –If optic neuritis is diagnosed, an MRI of the brain and orbits is indicated to evaluate for multiple sclerosis

  Treatment

  • Corneal abrasion: Topical antibiotics with or without cycloplegic agents; NSAIDs; patching may be the preferred treatment, depending on the size of the abrasion and the patient's level of discomfort
  • Bacterial conjunctivitis: Topical antibiotics
  • Allergic conjunctivitis: Topical antihistamine/mast cell stabilizers
  • Chemical conjunctivitis: Copious irrigation, topical cycloplegics, and topical antibiotics
  • Anterior uveitis: Cycloplegic agents, topical steroids, treat secondary glaucoma and underlying disorder
  • Migraine: Abortive therapy (triptans), oral pain medication, antiemetics
  • Meningitis: IV antibiotics
  • Episcleritis: Topical steroids in moderate to severe cases
  • Subarachnoid hemorrhage: Emergent neurosurgical consult

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

More About Photosensitivity

• Back to disease: Photosensitivity: Introduction
• Next Book Extract About Photosensitivity: PHOTOPHOBIA (Differential Diagnosis in Primary Care)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

 » Next page: PHOTOPHOBIA (Differential Diagnosis in Primary Care)

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