Suggest treatment for persistent sharp pain in the eyes

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Posted on Fri, 27 Jan 2017 in Headache and Migraines
Question: My uncle is experiencing an issue that started 3 days ago. When coughing or bending over to pick something up (straining) he experiences a sudden sharp pain in his right eye that radiates to the back of the frontal lobe. It lasts about 3-5 minutes and resolves spontaneously. No changes in eyesight or pain in the actual globe of the eye, pain comes from behind the eye. Significant history is leukemia (on radiation tablets), COPD, 76 years old. Doctor is not close - he goes to VA in another state. He wants to know if this is a serious issue that he should seek medical care for locally.Additional assessment - he is having no sinus symptoms at this time and has no fever.
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Answered by Dr. Dariush Saghafi 2 hours later
Brief Answer:
Orbital Pain

Detailed Answer:
Good afternoon. I'm sorry to hear that your uncle is experiencing these difficulties.

I am a neurologist at the XXXXXXX VA and know the system well. I'm sure there must be neurologists in your uncle's VISN (VA designation for different regional territories) and if I were in his position I would go to get checked out. Although, it may not turn out to be anything significant I would want him checked out for a possible dilatation or abnormal connection of some sort of blood vessels that lie behind the right eye or globe. Symptoms as you describe (if not sinus) certainly can be something more significant such as an aneurysm or fistula which can detour blood flow and cause problems.

I don't think the leukemia has much to do with his presentation and I don't think he necessarily has anything such as temporal arteritis although that specter is always raised when discussing sharp and painful sensations in the area of the eyeball. So I'm sure a good neurological evaluation will take that very low probability differential into consideration.

The pain is much too prolonged for this to be a trigeminal neuralgia but there could be an entrapment of a twig of the ophthalmic nerve which is in that area which upon changes in posture incites or increases compression which upon changing position takes time for the nerve to quiet down....so that could be a possibility as well.

Bottom line is I think a good neurological examination would do your uncle well and if the neurologist can't particularly find anything then, you can have him check with ophthalmology where they can check intraocular pressures and test the integrity of the contents of the globe and make sure his thyroid hormones are in line, etc.

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This query has utilized a total of 15 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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