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What causes eye pain and irritation with history of migraine?

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Dr. Dadapeer K

Ophthalmologist

Practicing since :2003

Answered : 5709 Questions

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Posted on Mon, 18 Aug 2014 in Vision and Eye Disorders
Question: DR MEYER,
I went to Optometrist on Wednesday afternoon, it is now Friday afternoon.
He took photo of back of my eyes and dilated. I was informed I have optic nerve drusen.
My eyes have been aching and slightly irritated, mostly in behind upper eye crease, since after exam.
I have 2 possibly related questions.
1) Could this aching and irritation be from allergy to dilating solution?
2) Would you see an Opthalmologist about the drusen considering my current and/or past history, or for another opinion?…………..Please see partial history below…………..
PARTIAL HISTORY: 54 year old female
I have had transient visual light flashes in the past, sometimes quick peripheral light scoops, and sometimes quick light ring more in the middle.
I have had 3 occasions in the last 10 years where the letter I'm looking at while reading is blank or absent. This went away when I stopped reading. The last time several years ago, when I stopped trying to read and looked up it was like I was seeing through a perfect grid/screen, and my eyes ached for a couple days. The Opthalmologist I saw the next week said possible eyestrain or migraine affecting both eyes.
I also have a long history of hypertension (taking meds). Occasionally I have a low +ANA(1-80), and I run low fevers lots (<100.5). Also I sometimes have slightly elevated RBC and slightly elevated TSH (other T's normal). In the past year I've seen doctors for hand problems, vertigo, feeling of vibration in head upon awakening from sleep (seldom includes arms or eye movements). I've had a bad depression.
I'm currently on Amlodipine, Lisinopril, and Pexeva (paroxetene). I'm considering a trial of Gabapentin for the vibration feeling.
Also have a long ago history of tick bite with Lymie looking rash, Lupus looking butterfly rash, and hospitalization for mystery infection (inc. WBC).
THANKS FROM FLORIDA
doctor
Answered by Dr. Dadapeer K 3 hours later
Brief Answer:
Eye pain not related to dilating drops or drusen.

Detailed Answer:
Hello Madam,
welcome to Health care magic.

I am Dr. DADAPEER K, an ophthalmologist and I answer health problems related to eye.

I reviewed your history. It seems you are treated for migraine in the past and you are on treatment for hypertension and for depression and vibration feeling.

Coming to your questions related to eye,
Eye pain and irritation is not related to the dilating eye drops, eye pain needs to be evaluated. This can be because of migraine or eye strain.
Since you are also having optic nerve drusen and it is commonly seen in eyes with hypermetropia, you need eye examination by refraction testing to rule out hypermetropia and possible eye strain arising from it.

Drusen by itself will not cause any problem other than a stable visual field defect. Hence drusen by itself does not require a second opinion.

Hope I have answered your questions and the information is helpful to you.

Thank you
With regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 17 hours later
So the brief light flashes, and brief light disk that runs across peripheral vision, also brief light ring phenomena, are not from the drussen. I had an optometric exam and nothing else appeared wrong with my retina. I have had the (few seconds) light phenomena for years, can have many occurrences in one day, and I seldom have any headache.
I have assumed they were from migraine without headache, then I thought the drusen might be causing them, but you say no. Upon research I read migraine visual aura lasts longer, and this brief light phenomena might be from specific seizures. However, the brief ring light I see sometimes seems to occur with blinking or eye movements sometimes. The other light phenomenon do not, and can happen without blinking or doing anything. (Brain MRI normal)

Is there any eye problem that might cause brief light ring related to eye movement?
Could this, or the other light phenomena be seizure related?
Also, about the drusen, could anything in my medical history have caused this, because I'm 54 and never been told about the drusen before?

THANKS FROM FLORIDA
doctor
Answered by Dr. Dadapeer K 43 minutes later
Brief Answer:
Flashes of light require evaluation.

Detailed Answer:
Hello
Welcome to Health care magic.

Drusen of the optic nerve indicate accumulation of the proteins and other materials in the optic nerve head resulting in formation of drusen.
Drusen usually occurs in people with positive family history and some times they are hereditary and majority of them will not cause any symptoms.
Rarely drusen can cause loss of peripheral loss of field of vision and they can be at increased risk of developing other retinal problems like central retinal artery occlusion. Rarely drusen can exert pressure on the optic nerve head causing symptoms of blackouts of vision.

However flashes of light are usually not caused by drusen and require evaluation by ophthalmoscopy to rule out problems involving the periphery of the retina like retinal thinning which are usually not related to drusen.
Since the flashes of light are not associated with headache in your case this requires evaluation by indirect ophthalmoscopy to look for retinal problems or complications caused by drusen.

This is not because of seizure related problem, no need to worry.


Hope the information is helpful to you.

Thank you
with regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 11 hours later
DR Dadapeer,

I had blamed my various light flashes on isolated Migraine auras, but I found on internet that this explanation does not fit well because the light phenomena is so brief.

The Optometrist I saw Wednesday dilated and look into my eyes with a light, while making me look in several directions. Could retinal problems be missed by this?

Would an appointment with an Ophthalmologist be a more detailed thorough exam of the retina?

THANKS FROM FLORIDA
doctor
Answered by Dr. Dadapeer K 22 minutes later
Brief Answer:
Detailed examination of retina is required.

Detailed Answer:
Hello
Thank you for the follow up question.

The flashes of light in your case does not look like to be because of migraine aura.
Hence you require examination of the retina by a ophthalmologist or preferably by a retina specialist to look for periphery of the retina and for complications of drusen as I had mentioned in the previous answer.

Hence I advice you to consult an ophthalmologist for detailed examination of retina.

Hope the information is helpful to you.

Thank you
with regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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