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Having pain around left eye. Diagnosed with shingles and prescribed with valtrex. Still having pain. Is it the correct diagnosis?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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I woke up 3 days ago with a sharp, stabbing pain in and around my left eye that was 12 on a scale of 1 - 10. It lasted for about 5 minutes during which I was screaming and could not control myself the pain was so severe. Then, it was gone -- completely. Later when I was chewing on bread the pain returned as bad as before but it only lasted a minute. I went to see a dentist, a periodontist and an endodontist. They ruled out any tooth or gum or bone involvement. Then I saw an opthalmologist and he ruled out any eye problem. Then, I went to an emergency room . They did a cat scan which ruled out any brain or head problem. Their exam led them to the diagnosis of shingles. They prescribed Valtrex, predisone, and hydrocordone. Since then I have had 5 additional episodes of pain around the left eye just as before taking the medicines, but not quite as severe or as long lasting. Is shingles the correct diagnosis? Am I doing the right thing?
Posted Fri, 22 Nov 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 58 minutes later
Brief Answer: The pain is neurological in nature Detailed Answer: Hi, Thank you for posting your query. One thing for sure is that your pain is neurological in nature, and is arising from the trigeminal nerve (fifth cranial nerve), which supplies sensation to the face, including the area around the eyes. Shingles is one of the conditions that can cause these symptoms, however, in most cases, skin lesions (such as blisters) would be seen in the same area. This condition is also called as post-herpetic neuralgia (PHN). In very rare cases, PHN can occur without the skin lesions. The other condition that can cause these symptoms is trigeminal neuralgia. Treatment is medical with medications such as pregabalin or carbamazepine to reduce/prevent the pain. I hope it helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
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Follow-up: Having pain around left eye. Diagnosed with shingles and prescribed with valtrex. Still having pain. Is it the correct diagnosis? 4 hours later
Should I continue to take the Valtrex and prednisone following the diagnosis of shingles, or should I switch to carbamazepine to combat trigeminal neuralgia?
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Brief Answer: Thank you for getting back Detailed Answer: Valtrex is an anti-viral drug and prednisolone is an anti-inflammatory drug. So, if you have the skin blisters due to shingles, you can continue to take them, otherwise, they are not necessary. The purpose of carbamazepine is to relieve pain (which valtrex and prednisolone can not do well). So, carbamazepine can definitely be started to combat pain. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: Having pain around left eye. Diagnosed with shingles and prescribed with valtrex. Still having pain. Is it the correct diagnosis? 12 hours later
Chewing -- even soft foods like macaroni -- frequently trigger a pain episode which starts in my cheek to the left of my nose and moves up to the left of my left eye. Does this shed any light on the diagnosis of the likely cause? Also, when I had my teeth scaled a couple of weeks ago novocaine was injected several times in my upper gum on the left side of my mouth and afterwards the area ached and was sore. Could the novocaine needle have damaged or sensitized the nerve and be causing the pain?
 
 
Answered by Dr. Sudhir Kumar 11 hours later
Brief Answer: Thank you for getting back. Detailed Answer: As I mentioned earlier, the most likely condition here is trigeminal neuralgia (TN). In this condition, the facial pain can get triggered by various activities such as brushing teeth, chewing, washing face, and even a breeze of air. Yes, I have had patients whose TN was triggered by dental procedures. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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