Ophthalmic Causes Of Headache
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Ophthalmic causes
of Headache
Dr Ashish Mahobia. MS;FRF;FNB
Sai Baba Eye hospital,Raipur
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Lets probe deeper
Ophthalmic Non ophthalmic
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Ophthalmologists are usually the first doctors to see a patient of headache
Some headaches are symptoms of medical emergencies.
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Good History taking
“Listen to the patient,He is telling you the diagnosis” - Dr William Osler
We interrupt in 30 secs* Headache (primary c/t?) Mild / mod /severe - Is it debilitating? (subjective)*Svab I. The time used by the patient when he/she talks without interruptions. Aten Primaria 1993;11: 175-7.
Blau JN. Time to let the patient speak. BMJ 1989;298: 39.
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Severe Headache
Half sided (HemiKrania=Migraine) ? Photophobia/phonophobia/scintillating
scotoma/nausea? Association - near work
stress ,travel
aur …aur…aur…aur..aur
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Severe Headache…
Remember!!
Migraine with aura (Classical migraine)
only 10-35% Migraine and without aura > 50% (Common
migraine) [1]
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Severe Headache… Ask to point out with finger(Head/face/eye/neck)
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Complete examination is MUST
Systemic/neurological Psychological analysis (Non verbal clues) Vision Motility Pupils Fundus Field defects
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All Ocular pathologies
Referred headache ACG Retro bulbar neuritis
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Vision..
Uncorrected refractive error Untreated hyperopia/Presbyopia Overcorrected Myopia Use Jacksons cross cylinders/Auto ref Accommodative spasm (eye pain, myopia,
and miosis) 20/20 vision doesn’t mean “No glasses”
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Refraction tips
Correct cylcloplegic Relax accomodation in A refractometer Myopics:Do the ‘Duochrome” test (each eye) High power glasses in last cell of trial frame See for pantascopic tilt
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Tips for refraction…
Undercorrect Myopes (Sply high minus) Do not overcorrect H metropes Reduce quarter of Cylindrical power Graded wear/increase of Cylindrical power
(except pseudophakes)
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Near correction
“Jitni door se hamesha kaam karte hain” Move it away…(see the needs and
occupation) Do not change the type of bifocal segment Do not change the axis which has been used
for years Do not change a comfortable refraction just
because your autoref says so Don’t over believe in autorefs/optometrists
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See the IPD
Prismatic effect Ensure good centration Sply Large power Children Large heads Spectacle /Frame
change Anisometropia (walk
around test)
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Strabismus
Latent Manifest All gaze positions Near and distance
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Convergence deficiency
Orthophoria for distance and exophoria for near show
Primary/H metropia/Myopia/presbyopia NPC: Normal 8 cms “Pencil push up” Over minus and less plus Base in prism/bifocals.
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Responsibility…
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Thank you!
Wish you and the whole family a V Prosperous & Joyous Diwali!
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Activation of the trigeminal autonomic reflex arc also accounts for Holmes adie pupil on the symptomatic side.
Eyelid edema, redness, lacrimation, or nasal congestion, during the migraine attacks are more likely to respond to sumatriptan, a serotonin receptor agonist.
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Cluster headache, also known as histamine headache severe and unilateral typically are located at the
temple and periorbital region. Associated with ipsilateral lacrimation, nasal
congestion, conjunctival injection, miosis, ptosis, and lid edema.
Each headache is brief in duration, typically lasting a few moments to 2 hours. Cluster refers to a grouping of headaches, usually over a period of several weeks.
To fulfill criteria for diagnosis, patients must have had at least 5 attacks occurring from 1 every other day to 8 per day and no other cause for the headache.