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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3176
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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My son has been having pain behind his right eye for over almost

Resolved Question:

My son has been having pain behind his right eye for over almost 2 weeks. He has had this occur occasionally in the past, but he bumped his head pretty hard at school, and these pains started on a daily basis a few days after the bump. We have been to the doctor a few times...they guessed a mild concussion, but he also has complained of ear pain. Any ideas?
Submitted: 3 years ago.
Category: Eye
Expert:  Dr. Dan B. replied 3 years ago.

Doctor DanB : Hello and thanks for your question. Can you chat?
Customer:

yes

Doctor DanB : How bad was this bump to his head? Did he have any bruising around his ear, behind his ear, or around his eyes? Did he lose consciousness? What were the circumstances surrounding this trauma?
Customer:

He bumped it on a metal pole on the playground. He had a big red bump on the top of his head which was very noticeable. No bruising, just redness followed by a very itchy head. From what he told me, he seems to remember all the details and didn't seem to have lost consciousness, but he was on the playground.

Doctor DanB :

Do you know the details of his pain? Is it constant or intermittent? Does it respond to ibuprofen and/or tylenol? How bad is it (on a scale of 1-10 for example)?

Customer:

The bump happened on a Tuesday. Friday and Saturday AM he woke up naseuos and vomited a bit. We went back to the doctors. Seemed like the head pains were subsiding, but he came home today with a very red face, low temp of 99.3 and exhausted...2 hour nap which is very unlike him.

Customer:

Details of pain....It comes on about once a day and can usually be subsuded with ad or ty. When it hurts, it's about a8, but has been a 9 or 10 a few mornings closer to the incident

Doctor DanB :

Has his vision been affected or his hearing? Has the eye been red or bulging?

Customer:

For the first time today, he said it looked like the room was shaking a bit, but now seems fine. I have not noticed any changes in hearing. His eyes have been red on and off.

Customer:

not bulging, but just a pinkness/redness to the whites of his eyes.

Doctor DanB :

Do you think this room shaking thing means he's dizzy or unsteady on his feet?

Customer:

He was lying down at the time on the couch after his 2 hour nap. Was able to walk around and wanted to shower (he says this helps) and has been taking one daily for the last few days to help the pain when it comes on. Seems steady on feet.

Doctor DanB :

Has he seen anyone besides his primary care doctor? Ophthalmologist, ENT, or Neurologist?

Customer:

I took him to the pediaticians office 3 times and the urgent care once for another opinion....I was thinking of trying something else because this just won't go away. He has fallen back to sleep already...very out of character! His appetite has not been great either.

Doctor DanB :

I'm actually concerned that there may be some intracranial bleeding going on here. He has enough symptoms that I think getting either a CAT scan or MRI scan of the head. It's not very high on my suspicion index, however, it certainly isn't very low either--I think he should be scanned. Has this test been brought up with any of these doctors?

Doctor DanB :

Sorry I mean to say, "He has enough symptoms that I think getting either a CAT scan or MRI scan of the head is necessary at this point."

Customer:

Yes, and I also researched a bit. They did not want to do a scan unless really necessary and I kind of agreed due to the radiation, however, they never mentioned the MRI. This is a safer method, correct?

Customer:

What are the most common symptoms of intracranial bleeding?

Doctor DanB :

Headache, altered mental status (behaving differently), dizziness, nausea, lethargy. I can certainly understand about the risks of radiation; I wouldn't want my children unnecessarily exposed to radiation either, but I think this is a calculated risk and in his case imaging is warranted, I believe. Yes, MRI can also show bleeding in the brain and is actually more sensitive at showing smaller, more detailed and fine damage in the head than CT and does not use radiation at all.

Customer:

The hit was pretty much where the "soft spot" was, so you know. I was worried about this fact as well.

Doctor DanB :

Yes, definitely a worrisome spot. I think given that his symptoms seem to be getting worse, rather than better, I would want my child getting this scan.

Customer:

So a MRI would be a prudent choice given we are looking at a specific area? Also, the lethargic behavior was not a factor until this afternoon....it is why I have once again become quite concerned. Is a low temp also an indication of some head trauma?

Doctor DanB :

The low temp I'm not thinking this is consistent with the head trauma. Yes, I think the MRI is a good choice here.

Customer:

Would you also suggest seeing his ENT or a Neurologist?

Doctor DanB :

Neurologist.

Doctor DanB :

But I wouldn't necessarily wait for the neurologist unless the MRI scan comes up negative. I would bring this issue up to his pediatrician as this isn't something that should wait for a referral to a neurologist.

Customer:

Ok, I will contact his pediatrician in the morning and ask for the test to be set up. Is there a lot of danger with the two weeks going by? Mentally he has been sharp and I have not noticed any personality changes.

Customer:

ok, so just get the MRI scheduled for tomorrow and go forward from there...

Doctor DanB :

I don't think the two weeks thing is a danger ultimately, but I wouldn't want to wait anymore. Yes, I think that's a good plan.


Do you have any other questions about this topic that I can help you with?

Customer:

Last question...it redness in the eyes an indicator? I have pointed this out to the doctors...they gave me claritin!

Doctor DanB : It can go along with this but is a soft association, not a hard and fast indicator.
Customer:

ok...thank you.

Doctor DanB :

You're welcome.


I am happy to be able to help you today. I will also be happy to answer any other questions until you have the information you need.


 


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My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor.

Doctor DanB : Do you have any other questions about this?
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3176
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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