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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3147
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Headache behind right eye

Resolved Question:

I have had a headache since March 22nd. I have been to an ENT and had a CT scan on my sinuses but it came back okay. The pain is behind my right eye and nothing that I do relieves the pain. I also have pressure and light sensitivity. Should I go to the ER?

Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Dan B. replied 1 year ago.

Doctor DanB : Hello and thanks for your question. Is the eye red? Is there any burning, grittiness, discharge, tearing, or intermittent vision changes? Do you wear contact lenses?
Customer:

I do not have any vision changes although my right eye feels strained. No redness, burning, discharge, tearing..I do wear contact lenses but have changed them out. I have even just worn my glasses to give my eyes a break, The pain came on very sudden and has never subsided completely.

Doctor DanB : How long have you been out of your contacts? How many hours per day do you wear your contact lenses? How many nights per week do you sleep in your contact lenses? Have you been to see your eye doctor yet?
Customer:

I went to my eye doctor in November of last year. I never sleep in my contact lenses. I usually wear my contacts 10 to 12 hours a day. I have never had a problem with my contact lenses before. This pain starts between my right eye and nose and goes back to my ear on the right side.

Doctor DanB : Okay thanks for that additional information. Because the same nerve that supplies sensation to the eye also supplies sensation to most of the face and ear, it is important to understand that this could be a problem related to the eye, or it could be just referred pain originating somewhere else and getting referred to the eye. Let me elaborate...
Doctor DanB : Even though you've not had a problem with your contact lenses to date, that doesn't mean that it's not possible for it to happen. I'm glad to see you don't sleep in your contacts. However, in someone who wears them the majority of time she's awake, you are still at risk for what's called a contact lens-induced keratitis. This can happen in contact lens wearers whose corneas become irritated by the bacteria in their tear film and the toxic products these bacteria produce.  These bacteria are normally found in everyone's tear film (or layers of tears that coat the eye).  However, this isn't a common thing seen in the general population, because many people don't wear contact lenses.  The contact lenses tend to be effective trappers, keeping these bacteria and their inflammation-inciting toxins trapped against the cornea, causing the cornea to breakdown and succumb to inflammation and infection.  The very first step in treating this is to refrain from using the contact lenses for at least a week, but sometimes it requires being out of them for even 2-3 weeks.  However, in most patients, this isn't enough to make it go away.  Most people will then require and antibiotic/steroid combination drop to help encourage the infection and inflammation to go away.  To that end, I would recommend visiting your ophthalmologist to get a complete exam and to get the medicine you need for this--unfortunately you can only get this medicine with a prescription from your doctor.  The other thing this may represent is....
Doctor DanB : what's called Trigeminal Neuralgia. This is a disorder where the trigeminal nerve, the nerve that supplies sensation to the face and to the eyes, becomes irritated, usually from where the nerve exits the brain. This is happening inside the head, but affects your face and eyes. It can happen for no apparent reason, or due to brain stem lesions. It can produce this sharp, electrical stabbing pain that you speak of, but usually causes more facial pain than eye pain. Unfortunately there is not always a cure for trigeminal neuralgia, but sometimes a reason for having it can be found and eliminated by surgery or medical therapy. Sometimes amitriptyline is prescribed for trigeminal neuralgia. Another medicine that can be taken for this include Neurontin.
Doctor DanB : Because there's no way to be sure whether this is a result from a local eye problem (such as contact lens-induced keratitis) and a more central type of problem like Trigeminal Neuralgia without having an examination, I would recommend seeing your ophthalmologist.
Doctor DanB : If your eye doctor is an optometrist, I would respectfully XXXXX XXXXX you see an ophthalmologist for this as these issues are out of the scope and practice of most optometrists. Does all this make sense?
Customer:

Would this also affect my sinuses? It feels like sinus pain but the meds for sinus infections do not work. I am not producing phlegm though. I am also running a low grade fever of 99.5 consistently.

Doctor DanB : No, a contact lens-induced keratitis would not be expected to affect the sinuses at all, and trigeminal neuralgia causes focused, targeted, sharp pains and the sinuses do not share those types of pain receptors, nor is trigeminal neuralgia associated with the sinuses or sinus pathology. Also, the lack of findings on a CT scan of the sinuses and the lack of any phlegm speak against a sinus process. While a 99.5 degree fever may be a little higher than normal for you, it doesn't suggest a significant infection, though it may be representative of some low-lying, consistent, underlying inflammation somewhere in the body.
Customer:

That makes sense. I have inflammation problems throughout my body on a regular basis and I am HLA-B27 positive. I guess I better get back to my Ophthalmologist. I just want to make sure that I don't need to go to the ER and that it is not life threatening,

Doctor DanB : No, this doesn't sound life threatening at all; I wouldn't worry about the ER, just try and make it to your ophthalmologist soon. Knowing you are HLA-B27 positive, there is a possibility that this could represent inflammation inside the eye called uveitis. This is a common finding in patients who are HLA-B27 positive. But again, only the ophthalmologist is going to be able to diagnose this on exam. Do you have any other questions about this?        
Customer:

No, thank you for your time

Doctor DanB : my pleasure. Good luck. Your feedback is important to me and will help me improve my encounter with future customers.  Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated.  If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.  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. Thanks for your inquiry! 
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3147
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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