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Ask Dr. Rick Your Own Question

Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Ive been getting headaches for years now, and every morning

Resolved Question:

I've been getting headaches for years now, and every morning when I wake up my left eye has fluid behind it (It is squishy when I push on it). It's only the left eye, no matter what side I sleep on.
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Rick replied 3 years ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

are you available to chat?

Dr. Rick :

Do you know, when they did the MRI, did they focus on your orbits and do the scan with and without contrast? Also, what treatments are you getting for the headaches? Is your vision affected in any way?

Customer :

The MRI was without contrast.

Dr. Rick :

Hi. Good morning

Customer :

I now have reading (progressive) glasses

Customer :

good morning

Customer :

My main issue is headaches on the left side of my left eye, and pressure on top of my head when it gets bad

Dr. Rick :

Does this fluid in the orbit seem to have any temporal relationship with the headaches?

Dr. Rick :

Also, do you have any vision problems during this time such as double vision etc?

Customer :

my vision is not really affected, other than if I wear my reading glasses, it helps a little

Customer :

It's a pressure in my head, that is affected by anxiety a little....

Customer :

the pressure gets worse at times for no real reason

Customer :

my left cheek is starting to tingle and feel a little numb

Customer :

i feel a constant tension on top of my head

Customer :

i feel a constant pressure in my left cheek

Customer :

bright light in my left eye intensifies the pressure

Customer :

ie. driving at night

Customer :

when it gets real bad, the tension goes from my left temple all the way over to my right temple

Dr. Rick :

Ok. It sounds like you are having a migraine, but I'm sure you've already been told that :) Let's try to think outside the box for a bit.....

Customer :

ok

Dr. Rick :

When it comes to this orbital squishy thing I think it would be useful if you could have the volume of your orbits measured when this is actually going on. The easiest way to do this is with an instrument called a hertel exophthalmometer. It measures how far your eyeballs are sticking out past the rim of your bony orbit -- an indirect measure of orbital volume. I would expect there to be a measurable difference between your eyes if you are able to notice squishyness, cheek numbness etc.

Customer :

ok. and it's only in the left eye, and it's every morning when i wake up

Customer :

no matter what side i sleep on

Dr. Rick :

The problem I believe you are having is that the squishyness may be transitory so it doesn't show up on exam or MRI ets

Customer :

once I stand up, the squishiness goes away

Customer :

then the pressure starts

Dr. Rick :

The other way to measure orbital volume, and see any possible vascular abnormality (which I think may be what is going on) is with an orbital ultrasound, once again at the ophthalmologists office

Dr. Rick :

that would be consistent with a vascular problem...

Customer :

I've been to 2 ophthalmologists, and they looked me over pretty good and couldn't find anything

Dr. Rick :

Has the squishyness been going on for years like the headaches, or is it kinda new?

Customer :

yes

Customer :

for years

Customer :

the pressure has been centered around my left eye the entire time

Customer :

and it's constant, and getting worse

Dr. Rick :

Well, if it was something "bad" it would have gotten a lot worse over the course of years. Vascular problems don't stay the same over that length of time

Customer :

my general dr. wants me to go see a specialist

Dr. Rick :

ok...getting worse

Customer :

it's slowly getting worse

Customer :

when you say vascular problems, what exactly are you referring to?

Dr. Rick :

That is a good idea. Hard to pick which specialist. I would lean toward an orbital surgeon or maybe an ENT that specializes in facial/orbit problems. One good though would be to go to a University setting where they have teams of specialists available down every hall

Dr. Rick :

an aneurysm, or dilated, leaking vein. Vascular tumors etc

Dr. Rick :

an MRI without contrast could miss this in the orbit, especially if they were focusing on your brain looking for causes of a headaceh

Customer :

so you think i should get an mri with contrast

Dr. Rick :

Are you near a major University? Mayo clinic in Rochester Mn would be a good choice, so would some of the Univ of Ca system schools......

Dr. Rick :

yup

Dr. Rick :

with a focus on the orbits.

Customer :

i'm in northern va

Dr. Rick :

Well, lots of good University programs on the East coast......

Customer :

I was thinking about going back to the first neuologist i've seen

Dr. Rick :

If you liked her, that is an excellent idea

Customer :

my insurance has been a pain about getting mris

Dr. Rick :

Ya, they are a pox on society

Customer :

lol

Customer :

could a vascular issue around my left eye, fix itself over time?

Customer :

or would it continue to get worse?

Dr. Rick :

you just need a doc who will think outside the box for a bit. If all this comes up negative then I would feel comfortable blaming it on a migraine varient.....

Customer :

right

Dr. Rick :

No. It stuff like that doesn't fix itself, and yes, it usually continues to get worse

Customer :

I feel like I'm just going thru the motions with these drs

Customer :

how would you fix a vascular prob (if that was the issue)?

Dr. Rick :

I can understand what you are saying. At least you are smart enough to look for other answers/options

Customer :

it makes as good sense as anything I heard so far

Dr. Rick :

with orbital surgery....not an endeavor to undertake lightly

Customer :

I was also in a car accident a few years ago, and got pretty bad whiplash on my upper back

Customer :

could a pinched nerve cause these symptoms?

Customer :

the squishiness in my eye, makes me think no

Dr. Rick :

that can cause problem with the carotid artery, but if that was a problem years ago you would be in very bad shape now.....so most likely not associated.

Customer :

ok

Dr. Rick :

nope. you are right on that count

Dr. Rick :

nerves aren't squishy...and they really can't get pinched in the orbit

Customer :

if one was pinched in the middle of my back, could that cause pain in my face?

Customer :

I'm grasping here :)

Dr. Rick :

not sure. That is more of a question for a neurologist

Customer :

just trying to get an expert opinion

Customer :

ok

Dr. Rick :

Well, at least you have some ideas on where to go now.....

Customer :

you have been a big help.....tks.... you think i should go back to the ophthamologist first and have them do that test?

Customer :

or go back to the neurologist

Customer :

and one last question

Customer :

could anxiety cause my issues?>

Dr. Rick :

try the neurologist. If you go to the ophthalmologist you should discuss the issue with her first and say you want to come in ASAP one morning when you are having symptoms to have your eyes measured with the hertel.....

Customer :

anxiety seems to make the pressure worse - but even when I'm having a ball, laughing, the pressure is bad

Customer :

the squishiness seems to go away in about 10 mins after standing up, then my cheek feels wierd, numbing sensation

Dr. Rick :

anxiety can make a lot of things worse, but before we blame this entire thing on that, or a migraine, I think it would be useful to rule out some of the things we've discussed here this mornign

Customer :

ok, sounds good, the neurologist it is

Dr. Rick :

numbing on cheek would go along with increased orbital volume as the nerve that serves the feeling in the cheek goes through the bottom of your orbit

Customer :

and I'll go from there....this is getting pretty anoying

Dr. Rick :

I hope things work out for you. Best of luck.

Dr. Rick :

And, now, the obligatory word from our sponsors: :o)


I hope that this information was helpful for you. Please, allow me get credit for my time and effort in assisting you and press the ACCEPT button for this assist. I will be glad to answer additional questions until you are satisfied. Thank you very much.

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Customer :

and the anxiety seems to be cause by me worrying about the pressure in my head

Customer :

not the other way arond

Dr. Rick :

I can believe that.

Dr. Rick :

Drop me a note, you can do that for free by requesting me or just adding it to this question, even after you "accept" the answer, and let me know what you find out if you don't mind

Customer :

ok, thanks again for your help.......can i save this chat?

Dr. Rick :

yes, you can print it out, and I believe you can copy/paste it into MS word etc. Not sure how else you save it....I've never been on your side of the screen :)

Customer :

ok, I figured it out - thanks again for your help, and have a good one!

Dr. Rick :

how do you save it incase others ask me?

Customer :

copy paste

Customer :

so select all the text, and copy

Customer :

then open word, and paste

Dr. Rick :

cool. thanks. Take care. It's now safe to push that pretty green button ;o)

Dr. Rick :

I will tell others who ask

Customer :

thanks again....cheers//Rob

Dr. Rick :

My pleasure Rob.

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7750
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
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