HeadWise HeadWise: Volume 2, Issue - Page 26

Not All Eye Conditions Are Emergencies Inflammation, dryness, bleeding and straining aren’t always emergencies. But if they aren’t addressed, they could trigger painful headaches. INFLAMMATION: Uveitis, or inflammation of the eye, is frequently mysterious in origin. It may be the result of a virus, bacteria, parasite or inflammatory disease. This leads to swelling and irritation of the uvea, the middle layer of the eye. The inflammation can cause blurred vision, light sensitivity, redness and headaches. Treatment for uveitis typically includes eye drops or the topical steroid prednisolone acetate (e.g., Pred Forte® or Omnipred®), which is applied four times a day or more. Treating the inflammation can relieve the headache, says Joel S. Schuman, MD, FACS, Eye & Ear Foundation professor and chairman at the University of Pittsburgh Department of Ophthalmology. Even with treatment, he warns that the pain and inflammation may take weeks to resolve, depending on the cause. Still, it is important to stick with treatment; untreated uveitis could lead to glaucoma, cataracts (clouding of the lens) and vision loss. DRY EYE: “When people complain about pain in both eyes, a common cause is dry eye,” says Deborah I. Friedman, MD, MPH, professor of neurology, neurotherapeutics and ophthalmology and director of the Headache and Facial Pain program at the University of Texas Southwestern Medical Center in Dallas. Symptoms of dry eye include eye pain, burning, itching, redness, blurred vision and the feeling of having sand in your eyes. Such symptoms could be the result of tear deficiency, low humidity in the surrounding environment, contact lens use, medication side effects, or a more serious medical condition such as lupus (a chronic inflammatory disease) or thyroid disease. When it comes to relief for dry eye, Dr. Friedman says “you need lubrication, not ibuprofen.” An ophthalmologist will typically recommend using artificial tears frequently throughout the day. Dr. Friedman says to avoid over-the-counter eye drops containing naphazoline (e.g., Clear Eyes®). “Naphazoline gets the red out, but it can cause rebound redness once the product wears off, leading users to become dependent on the medication over time,” she says. “That’s just counterproductive.” For more severe cases, cyclosporine ophthalmic drops (e.g., Restasis®) are prescribed. In extreme cases, the physician may opt to plug the tear duct in order to reduce drainage of tears and keep the eye lubricated. Once the eye is properly lubricated, the pain should be relieved. BLEEDING: Bleeding in the eye can be caused by blunt trauma to the eye, penetration of the eye or, rarely, cancer or inflammation. Bleeding can raise the level of pressure in the eye that can lead to eye pain, blurred vision and headaches. “The best course of action is to wait it out,” Dr. Schuman says. “Unless it’s a massive hemorrhage, the eye pressure is high or the blood is staining the tissues of the eye, the eye tissue will usually absorb the blood on its own.” If the hemorrhage is severe, the physician may opt to drain the blood surgically. In the meantime, drops of atropine (e.g., Isopto Atropine®) and/or steroids can be used to treat the pain and inflammation. Patients should not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to treat this condition, as these medications can promote bleeding. EYESTRAIN: Often eye pain and headaches are simply the result of eyestrain, a sign that a patient may need glasses or a stronger eyeglass prescription. Eyestrain headaches usually occur after periods of reading or at the end of a workday spent focusing on a computer screen. “When a patient is suffering from eyestrain, a change in eyeglass prescription will often solve the problem,” Dr. Schuman says. “If a new prescription doesn’t fix it, this may indicate the presence of some other eye problem; for example, difficulty reading and eyestrain can be symptoms of a cataract, which could be cured with surgery.” A proper diagnosis is vital and a treatment plan to treat the underlying cause can help to relieve both the eye problems and the accompanying headaches. To make things more complicated, researchers in the Jan. 2004 issue of the journal Headache revealed that pituitary apoplexy is often misdiagnosed as meningitis. For this reason, the researchers say it is important for anyone who presents with these symptoms to get a magnetic resonance imaging (MRI) scan of the brain to determine the true cause. Researchers in the meningitis study wrote that pituitary apoplexy is rare but life threatening, adding that rapid treatment is necessary and usually involves administration of high-dose corticosteroid (e.g., cortisone, prednisone) and surgery to remove the tumor. GIANT CELL ARTERITIS Similar to pituitary apoplexy, giant cell arteritis (GCA) is an emergency condition that, if left untreated, can cause headache, vision problems or even stroke, Dr. Samuels warns. Specifically, the condition involves an inflammation of the lining of the blood vessels in the brain. While the cause of this inflammation is unknown, it is suspected that it may be the result of an immune response gone wrong, notes the NIH. People with GCA are usually older than 50. They may experience a new onset headache that is throbbing in nature, pain in the jaw and visual symptoms including blurred or double vision. Unfortunately, these symptoms also mimic tension-type headaches, migraine and cluster headaches. A blood test or biopsy can help a physician make a proper diagnosis. Administration of oral or intravenous corticosteroids can treat the problem as well as relieve the headaches caused by this condition, Dr. Schuman says. In each of the eye-related conditions noted here, a proper diagnosis is vital and a plan to treat the underlying cause can help to relieve both the eye problems and the accompanying headaches. Simpson now recognizes that if she had followed her treatment plan, she likely wouldn’t be facing her current vision and headache issues. “My advice to people is to stay on your treatment and don’t miss appointments with your doctor,” she says. “If you don’t follow your treatment plan, it will only get worse.” Hw FREDERICK SCELZO, MD, Evan- The National Headache Foundation has a list of headache specialists who may be of help. See www.headaches.org or call 888-NHF-5552. 28 www.headaches.org | National Headache Foundation 29