Eye Complaints / Facial Pain

Thomas R. Bodette, D.C., CCSP

Visual Dysfunction

Loss of central vision:

Cataracts (most common cause), Retinal detachment Glaucoma (buildup of pressure in anterior chamber before Canal of Schlemm) Retinitis Pigmentosa (younger people, poor night vision, often present as clumsy or accidentprone)

Loss of peripheral vision:

Acute loss of vision = Vascular, traumatic

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Visual Dysfunction

Chronic loss of vision:

Macular degeneration Presbyopia Migraine, Vitreoretinal traction Glaucoma, corneal disease Amaurosis fugax (thrombus in retinal artery, pt describes that a curtain goes up when thrombus dissolves) Multiple sclerosis (30-40 y.o) Papilledema

Flashes of light

Halos around light:

Transient loss of vision:

Visual Dysfunction

Diplopia (monocular):

Cataracts (unilateral) Refractive error Vascular, tumor, myasthenia gravis, multiple sclerosis Migraine Macular degeneration
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Diplopia (binocular):

Distorted vision:

Facial Pain

Neuralgias:

Trigeminal (tic douloureux)

Described as 12/10 pain Usually mandibular and maxillary divisions Patients may be suicidal (psychologically painful)

Glossopharyngeal
Rare, related to swallowing and movement of pharynx

Sphenopalatine ganglioneuralgia
Brain-freeze, Ice-cream headache

Facial Pain

Sinusitis Dry eye, gritty eye:

Hyperthyroidism (due to exophthalmos; what is the BP?) Sjgrens Syndrome (autoimmune attack of exocrine glands that produce tears and saliva) Retro-orbital = headache, tumor UTI = Reiters Syndrome
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Eye pain (w/o vision loss):

Facial Pain

History clues:

1) Short, sharp recurrent pain = neuralgias 2) Deep, dull pain worse with bending forward or atmospheric changes = sinusitis 3) Pain radiating from front of ear and with opening the mouth = TMJ dysfunction 4) Pain with chewing or hot/cold foods = dental problems or brain freeze

Selected Causes of Vision Loss

1)

Acute-angle closure glaucoma

Severe pain, halos around light, blurred unilateral vision, nausea and vomiting (patient may have just had his/her eyes dilated) Less than 10% of all glaucoma cases Senior; will present with eye redness, cloudylooking cornea, possibly hyperopic Etiology: blockage of outflow of aqueous humor from the anterior chamber increasing pressure and pain (medical emergency)
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Selected Causes of Vision Loss

2)

Open-angle glaucoma
Etiology unknown; patient often describes that the peripheral field of vision has been cut (usually the nasal half) Usually presents bilaterally Patients often predisposed after past eye surgery or trauma Evaluation in chiropractic setting is difficult (elevated intraocular pressure not indicative)
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Selected Causes of Vision Loss

3)

Age-related macular degeneration

A) Dry: Slowly developing, painless, central vision loss B) Wet (disciform): Sudden, painless loss of vision (caused by neovascularization) Leading cause of blindness in geriatric pop. Fundoscopic findings: drusen, hemorrhages, exudates

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Selected Causes of Vision Loss

4)

Retinitis pigmentosa
Affects children and young adults (child reports or parents notice decreasing night vision) Hereditary condition (degeneration of the retinal rods occurs, peripheral ring scotoma) Dark pigmentation of central retina, yellow waxy disc observed on fundoscopy Genetic counseling recommended

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