HEADACHE AND EYE.

                This is really very interesting topic. As more than half of the patient visiting to any eye doctor have headache as main complaint. Half of them are referred by some genral practitioner and half of them are self motivated. How much of them really have ophthalmic cause for headache in my opinion hardly 10 % of them have significant eye problem that may cause headache.

Since I am an ophthalmologist let us first discuss the ophthalmic cause of headache.

The headache associated with vision

The commonest eye problem that may lead to headache is over straining of cilliary muscles 

What is cilliary muscle? these are the muscles present in our eyes which help to focus from distance to near like focusing lens of the camera When you are engaged in near work these muscles are in action If you are doing near work like reading or writing for whole day they ultimately get fatigue and that leads for frontal headache i.e. headache across the forehead. If you are presbiopic (above 40 years of age inability to focus for near things develop which is called presbiopia) your natural lens looses it elasticity and cillary muscles have to strain even more causing more headache.

The headache associated with near vision can be prevented in following ways

1.       Do near work (e.g. reading and writing) in proper illumination.

2.       Posture is also important do not hold object close to eyes minimum distance should b 25 to 30 cm (over convergence for eyes can also lead to headache)

3.       Use proper presbiopic spectacles if you are advised by your eye  doctor

4.       Avoid continuous near work take some interval of rest in between

5.       Computer vision syndrome (cvs) is also leading cause of headache and is discussed in detail in  ‘Protect your eyes for computer post on this blog

The next important cause of ophthalmic headache is refractive errors

Hypermetropias (plus number spectacles) are worse than myopias as for as headache is concerned Astigmatism (cylindrical numbers) can also lid to refractive headaches

Wrong glasses out dated glasses can also lead to headache therefore it necessary to get periodic check up for your vision

In children over accommodation (to overcome under laying hypermetropia) which can also lead to cross eyes (squint), may present with headache.

The non visual cause of ophthalmic headaches

  They are generally associated with other signs and symptoms

Headache proceeded with aura (flashes, objects or temporary bluring of vision prior to headache)

Is ocular migraine

Dull to sever headache may be associated with redness and watering and blurring of vision is acute or sub acute attack of glaucoma

Inflammations for eye like scleritis, uveitis generally associated with ocular symptoms

The non ophthalmic causes of headache are many and 90 % of patient visiting to ophthalmic opd are having them

They can be classified as per department

1 (brain) migraine, cluster headache, hypertetion. Hypotension space occupying lesion etc

2net headache sinusitis sinusitis patients are commonest patient visiting to ophthamology opd as

Most of the sinuses (cavities in scull bone drain in the nose) are in close proximity of the eye

And the inflammations in then causes pain around eye globe there fore patient come to eye doctor

3 psychiatry departments around 60 % of all headaches are tension headaches which are along fore head or at the back side of your head we shall discuss about it some other day

I ma going to present Wonderful self explanatory slide show by Dr. Aashish Mahobia

Which is more useful for doctors but you can also get some useful information out of it.

       

Ophthalmic Causes Of Headache

COUNJUNCTIVAL EPIDEMIC HOW TO FACE?

Viral keratocounjunctivitis also known as Epidemic Keratoconjunctivitis (EKC) is a contagious eye infection, though cornea is involved conjunctiva is far commonly involved but due to increased use of local steroids as a self medication corneal involvement is becomming commoner now days.

 It is highly contagious and can last as long as a month.

It occurs mostly in places of close human contact, such as schools, hospitals and office environments.

Causes and spread of Epidemic Keratoconjunctivitis

EKC is caused by a virus called adenovirus. Adenovirus is the commonest virus infecting our upper and lower respiratory tract coursing common cold, sore throat, bronchitis etc.

            The most common way it develops is by direct contact with tears or other fluids from infected eyes. Close human contact among members of households, offices, in jam packed local trains etc. spreads infection.

Symptoms of Epidemic Keratoconjunctivitis

People with EKC usually complain of a sudden onset of eye redness, irritation, soreness, light sensitivity and excessive tearing. Some people with the infection say that it feels like a piece of sand or foreign body is in the eye. Both the eye and eyelid can become swollen. The viral infection usually involves one eye first, and then eventually infects the other eye. People with EKC may have significantly blurred vision for several days.

Diagnosis of Epidemic Keratoconjunctivitis

            The patients reach to an eye doctor in the initial phase of the epidemic only. The initial part of the disease (only conjunctivitis) is congestion tearing photophobia swelling of the lids and mild to moderate pain. Blurring of vision occurs in some patient when cornea  gets involved (kertocounjuctivitis)causing white punctate sub epithelial infiltrates called superficial punctate keratitis(spk)Which may stay for very long period of time and in very rare cases cause permanent scarring.

Treatment of Epidemic Keratoconjunctivitis

            Since antibiotic medicines are not effective in treating EKC, treatment focuses on alleviating unwanted symptoms. In mild cases, doctors prescribe cold compresses, and vasoconstrictors. Frequent eye washes with clean water also help to decrease viral load and control infection

Dos and don’t s in the treatment of ekc

1 Dos

1. As far as possible avoid unnecessary public contact by travelling attaining school, office, etc at list in infective phase (when eyes are watering)

2. Keep your napkin, towel, soap etc isolated to avoid contact spread at home.

3. Use dark goggles they are helpful against photophobia and help in spreading droplet infection

4. Consult your ophthalmologist before using any eye drops

Don’ts

3. Avoid self medication some times it may end up in loosing your vision

4. Avoid steroid local drops (the drops having contents like dexamithazone, prednisolone betamethazone etc as a single drug or in combination

Following are the complications of using local steroids without consulting ophthalmologist

1.    Simple conjunctivitis becomes keratocounjunctivitis that is superficial punctate keratitis (spk) develop and causing blurring of vision for long period of time (some times 6 months to 1 year)

2.    Spk goes with steroids but reappears as soon as steroid are tapered

3.    Sub counjunctival hemorrhage are commoner with use of local steroids the red eyes