HeadWise HeadWise: Volume 2, Issue - Page 24

or through laser scanning images, an ophthalmologist should be able to make the diagnosis. While it can’t be cured, open-angle glaucoma can be managed through the use of eye drops and medication to lower eye pressure. If medication cannot be tolerated or is ineffective, laser therapy or surgery may be an option, says Joel S. Schuman, MD, FACS, Eye & Ear Foundation professor and chairman at the University of Pittsburgh Department of Ophthalmology. 2. ACUTE ANGLE-CLOSURE GLAUCOMA: This type of glaucoma comes on quickly and severely and signals a medical emergency, says Brian Samuels, MD, PhD, assistant professor of ophthalmology and a glaucoma specialist at the Eugene and Marilyn Glick Eye Institute at the Indiana University School of Medicine in Indianapolis, Ind. The drainage angle in the eye suddenly becomes blocked. In this case, symptoms do appear and often worsen over time. These may include nausea, severe pain in or around one eye, cloudy vision and red eye. This last symptom may or may not have to be present for glaucoma to be diagnosed. Researchers wrote in the Oct. 1998 issue of the journal Headache that it is possible to have glaucoma without redness. They cited three cases in which patients were diagnosed with headaches and migraines that lasted for at least a year. All three patients had “white eye,” or a normal look to the eye without any redness. With the use of a gonioscopy, glaucoma was discovered in all three instances. Development of Glaucoma HEALTHY EYE GLAUCOMA To make diagnosis more complicated, acute angle-closure glaucoma can be confused with cluster headache, which also involves head pain (usually at night) and redness. In one case mentioned in a 1991 issue of the Indian Journal of Ophthalmology, a 47-year-old man experienced severe pain around the left eye, watering of the eye and redness. He was misdiagnosed with acute angle-closure glaucoma but later learned he had really been experiencing cluster headaches. To establish a proper diagnosis quickly, ophthalmologists typically measure the actual intraocular pressure of the eye and continue to measure the pressure until it has dropped, according to The Glaucoma Foundation. Once diagnosed, treatment usually involves medication to prepare the eye for surgery. Typically surgery can be performed with laser therapy (called iridotomy). In angle-closure glaucoma, the laser creates a hole in the iris so the iris can fall back to its normal position and relieve the blockage of the drain of the eye, Dr. Schuman says. That allows the fluid to drain more easily from the eye into the blood stream. Once the block is released, the glaucoma and headaches should go away. 3. CONGENITAL GLAUCOMA: This form of glaucoma involves abnormal eye development. As such, it is usually seen in babies and is inherited. As with acute angle-closure glaucoma, redness and cloudiness of the eye itself can signal a problem, as can sensitivity to light and tearing. Eye drops generally aren’t advised here. Instead, congenital glaucoma is treated with eye surgery. According to the NIH, babies “do well” when surgery is done early. 4. SECONDARY GLAUCOMA: This type of glaucoma lems. This is the case for pituitary apoplexy (also known as a pituitary infarction), which involves the death of tissue in the pituitary gland. In most cases, this condition is the result of a noncancerous tumor in the pituitary gland that spontaneously bleeds out or hemorrhages, Dr. Samuels says. People with this condition may experience paralysis of the eye muscles, which can lead to double vision. Researchers wrote in the March 2007 issue of the journal Headache that pituitary apoplexy can be accompanied by a sudden, sharp “thunderclap headache,” named for its impact and severity. Unfortunately, researchers add, diagnosis based on the thunderclap headache alone is tough because that type of headache can be symptomatic of any number of conditions, including brain aneurysm. ADVERTISEMENT is the result of some other condition, which might include eye disease or trauma. That means an event could cause glaucoma, which then could cause head pain. To stop the domino effect, it is necessary to start by treating the underlying condition. PITUITARY APOPLEXY While some headaches are caused directly by an eye condition, other headaches appear alongside vision prob- 26 www.headaches.org | National Headache Fou ][ۂ‚