Headache and eye diseases

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Headache and eye diseases

• Dr.Suseela.B.Nair

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RED FLAG Headaches

• Headache with altered mental status
• Headache with focal neurological findings
• Headache with papilledema
• Headache with meningeal signs
• The worst headache of life
• Headache in the patient with AIDS

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Headache Presentations

• Patient with a history headaches with the same
  headache
• Patient with history of headaches and different
  headache
• Patient with the first time severe headache

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The Deadly Dozen

• Subarachnoid headache
• Acute closure glaucoma
• Carbon monoxide poisoning
• Preeclampsia
• Hypertensive encephalopathy
• Meningitis / encephalitis
• Temporal arteritis

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The Deadly Dozen (cont)

• Cavernous sinus thrombosis
• Mass lesion/ tumor/ abscess
• Cerebral vascular accident
• Epidural/subdural
• Hydrocephalus

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Papilledema
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GlaucomaAcute Angle Closure

• anterior chamber outflow tract blocked by iris
  root
• accumulation aqueous humor in posterior chamber
  IOP
• optic nerve and retinal ischemia

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GlaucomaPhysical Examination

• red eye
• non-reactive, midposition pupil
• pupil may have irregular margins
• hazy or steamy cornea
• increased intraocular pressure, usually greater
  than 50 mmHg
• shallow anterior chamber

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Intraocular Pressure Measurement

• Palpation
• Schiotz tonometer, Goldman applanation tonometer,
  Tonopen
• 10-20 mmHg normal
• 20-27 mmHg with visual loss - treat
• gt 28 mmHg - treat

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Glaucoma Treatment

• Reduce pressure
• 1. Topical agents - B-blockers
• 2. Oral agents - Acetozolamide
• 3. Miotics - Pilocarpine
• 4. IV agents - Acetozolamide, Mannitol
• Ophthalmologist consult - peripheral iridectomy

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Temporal Arteritis

• Generalized vasculitis unknown etiology
• Visual loss most common sequelae
• Onset usually after age 50
• Females affected 4 times more than males

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Temporal ArteritisHistorical Features

• Headache - dull onset, intensifies to burning,
  jabbing pain. Localized over temporal arteries.
• Jaw claudication
• Visual symptoms - blindness without warning
• Systemic symptoms

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Temporal ArteritisPhysical Examination

• Low grade fever
• Scalp tenderness prominent
• Temporal artery tenderness

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AION
Retinal Vascular occlusion
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Temporal ArteritisManagement

• ESR elevated - often gt 100mm/hr
• Anemia and leukocytosis
• Temporal artery biopsy
• Prednisone 60-80 mg/day

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Hypertensive Encephalopathy

• Usually occurs in patients over age 40
• Results from cerebral hyperperfusion from loss
  autoregulatory mechanisms
• Symptoms improve with lowering the blood pressure

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HTN EncephalopathyHistorical Features

• History of noncompliance
• Symptoms progressive over days
• Headache - generalized, non throbbing
• Nausea and vomiting
• Confusion to coma
• Blurred vision

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HTN EncephalopathyPhysical Examination

• Diastolic BP gt 140 mmHg
• Altered mental status
• Seizures
• Papilledema
• Retinal hemorrhages
• May have focal neurological findings

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Ocular Ischemic Syndrome

• Caused by atherosclerotic changes in carotid
• Elderly individuals
• Vague headache
• Vision loss may be mild to severe, may be
  attributed to other causes like cataract
• Slit lamp evaluation
• anterior chamber flare and cells (Ischemic
  iritis)
• cataract
• rubeosis iridis

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Ocular Ischemic Syndrome

• Fundoscopy
• mid peripheral retinal hemorrhages venous
  dilatation
• disc pallor
• IOP may be low even with closed angles due to
  decreased ciliary body perfusion

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Convergence insufficiency
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Herpes zoster ophthalmicus (Pre herpetic
neuralgia)
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Accommodative spasm
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Uncorrected refractive errors
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Presbyopia
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Computer vision syndrome
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MIGRAINE
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Cluster head ache
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Others

• Anterior uveitis
• Primary open angle glaucoma / secondary glaucoma
• Optic neuritis
• Orbital inflammatory disease
• Scleritis
• Drugs eg Pilocarpine

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thank you