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What Is The Cause Of Eye Pain And Headache With Slight Photosensitivity?

Posted on Tue, 4 Mar 2014

Question: Hello, I woke up 12 days ago with left sided face pain primarily over maxilla, and eye pain that has been a consistent dull ache. Additionally, yesterday i developed a persistent headache with slight photosensitivity. Never had any of these sxs before. Saw optho and ENT told most likely neuralgia as CT s contrast was negative (some thickening in L sinus). I have been on Valtrex, Prednisone, Levaquin and Augmentin with no relief. Pain remains 6/7. Labs are pending. Had a bad URI/sinusitis 2 weeks prior onset. Thanks, XXXXXXX NP

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer: Possibly neuralgia/atypical facial pain Detailed Answer: Hi, Thank you for posting your query. I have noted your symptoms and also the fact that CT with contrast was negative. Also, any eye or ENT problem has been excluded. In this scenario, the most likely cause of your symptoms could be a neuralgia- pain arising from a nerve. In this case, the most common nerve to be affected is trigeminal nerve, which arises in the brain stem and comes to supply sensations over face. The underlying causes could be ischemia (lack of blood supply), demyelination (damage to covering of nerve), infection, compression of the nerve by a blood vessel, etc. This can be confirmed by doing an MRI of brain, along with angiogram. As of now, you could take carbamazepine tablets or pregabalin capsules for pain relief. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (8 hours later)

Thank you for your reply. Actually, the CT was s(without) contrast and it was only of the sinuses. Should i proceed with head CT with contrast prior to MRI/angiogram?? And what exactly is the CT looking for or is just to r/o sinus? Can you also give me the Differential? Thank you so much! I am very pleased to find telemedicine working so well.. XXXXXXX

Answered by Dr. Sudhir Kumar (59 minutes later)

Brief Answer: MRI would be preferred. Detailed Answer: Thank you for getting back. In your case, MRI of brain with angiogram would be preferred as compared to CT brain with contrast. We are looking for a problem in the region of trigeminal nerve, which arises from the pons (brainstem region). Typically, we want to exclude ischemia (lack of blood supply), demyelination (damage to the nerve covering) or infection in that area. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (38 minutes later)

Thank you very much...Best, XXXXXXX

Answered by Dr. Sudhir Kumar (4 minutes later)

Brief Answer: Thank you. Detailed Answer: Thank you and best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar