Next up, let's talk about a
patient experiencing eye pain.
This is a 60 year old man
with a history of hypertension
who's presenting to the emergency
department with right eye pain
that started two days ago.
Now it's associated with blurry vision.
The eye is a very sensitive structure
with a lot of different moving parts.
Let's review a little bit of the anatomy right here.
So first off, we divide the
eyeball into an anterior chamber
which is in front of and includes the lens,
and then a posterior chamber which
includes the vitreous and the retina.
You can notice that also lining the
anterior chamber is your cornea,
which once you get to the periphery
of visual fields, you have the sclera
wrapping around the entirety of the eyeball.
On the retina, the optic disc area
is the blind spot in our vision,
and it's the place with no rods or cones, which
also makes it the easiest place to visualize
as patients don't experience as much discomfort
when we're shining light in that area.
Broad overview of things that can cause
eye pain - we have external causes,
internal causes, and we'll go into
some more details by each of these.
And then, of course, moving away
from painful causes of eye discomfort,
there are also some painless manifestations that
we're going to look for in the eyes as well.
Starting with external causes
of eye pain, we have trauma
which may be as simple as just a corneal
abrasion or a patient who sustains severe trauma
may experience an orbital fracture.
Infectious causes like conjunctivitis, which is
very common whether bacterial, viral or allergic,
and then, of course, hordeola or styes,
which can be in the upper or lower eyelids.
And then many times, rheumatologic
diseases may manifest in the eye
with either uveitis or scleritis,
or episcleritis as well.
Reviewing some of the internal causes of
eye pain, a normal eye is depicted here,
contrasting that with open angle
glaucoma, which tends to be painless.
But the painful process, closed angle
glaucoma is an ophthalmologic emergency.
And then moving farther back in the skull,
we have elevated intracranial pressure,
which can also cause headaches, whether caused
by a brain tumor, occluding the fourth ventricle
or patients who have pseudotumor cerebri
can also have elevated intracranial pressure.
And we would be able to visualize that, looking
at the back of the eye, looking for papilledema.
And looking at more benign causes of eye
pain, there are particular headache subtypes
which can manifest with eye pain,
in particular cluster headaches.
Simply patients who have the flu
may have retroorbital pain.
And then certainly migraines can present
with unilateral frontal pain as well.
So with all those different possibilities in mind,
we're going to have to do a thorough exam.
We're going to be thinking about glaucoma,
whether closed angle or open angle.
We're looking for signs of conjunctivitis,
uveitis, corneal abrasions.
And also maybe this is not an eye problem at all.
And just a cluster headache would
be a diagnosis of exclusion.