1 eye complaints and facial pain su12

7/27/2019 1 Eye Complaints and Facial Pain SU12

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Eye Complaints / Facial PainThomas R. Bodette, D.C., CCSP


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Visual Dysfunction

Loss of central vision:

Cataracts (most common cause),

Retinal detachment

Loss of peripheral vision:

Glaucoma (buildup of pressure in

anterior chamber before Canal of

Schlemm)

Retinitis Pigmentosa (younger

people, poor night vision, often

present as clumsy or accident-

prone)

Acute loss of vision = Vascular,

traumatic

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Visual Dysfunction

Chronic loss of vision: Macular degeneration

Presbyopia

Flashes of light

Migraine, Vitreoretinal traction

Halos around light:

Glaucoma, corneal disease

Transient loss of vision:

Amaurosis fugax (thrombus inretinal artery, pt describes that a

curtain goes up when thrombus

dissolves)

Multiple sclerosis (30-40 y.o)

Papilledema 3


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Visual Dysfunction

Diplopia (monocular):

Cataracts (unilateral)

Refractive error

Diplopia (binocular): Vascular, tumor,

myasthenia gravis,

multiple sclerosis

Distorted vision:

Migraine

Macular degeneration

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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

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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)

Eye pain (w/o vision loss): Retro-orbital = headache, tumor

UTI = Reiters Syndrome

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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

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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, cloudy-

looking cornea, possibly hyperopic Etiology: blockage of outflow of aqueous humor

from the anterior chamber increasing pressure and

pain (medical emergency)8


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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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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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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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1 eye complaints and facial pain su12

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