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Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2126
Experience:  MS Ophthalmology with 11 years of surgical expereince
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I woke up a couple hours ago around 2:30 am experiencing constant

Resolved Question:

I woke up a couple hours ago around 2:30 am experiencing constant throbbing of my left eye. I have had this condition off & on for several months. I can't get back to sleep. I have multiple sclerosis (diagnosed in 1984) & my neurologist did not find anything in recent MRI. I am 67, work part-time as a judge & mediator & can not function effectively without a full night's sleep. My cardiologist said that it could be migraines, but I don't experience head-aches. The throbbing does not hurt, but is damn annoying & I can't fall back asleep. How can I get rid of the throbbing & get back to sleep?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. A.S. Desai replied 1 year ago.

Dr. A.S. Desai :

Hello, Thank you for the question.I am Dr.A.S.Desai and I look forward to assisting you .

Dr. A.S. Desai :

Are you available for chat now?

Customer:

Yes

Dr. A.S. Desai :

Do you have any known history of sinusitis? Have you had a bout of common cold in the recent past? Any caried tooth?

Customer:

A history of allergies. Nothing severe. I take allegra.

Dr. A.S. Desai :

Are you experiencing only throbbing ( more like a pulsation) of the left eye or is there severe pain too?

Customer:

Only throbbing in my left eye. It feels like it is coming beneath the eye. It is almost painful, but is just very annoying.

Dr. A.S. Desai :

Sorry about asking so many questions..... The vision in the left eye is normal, right? Does the throbbing stop spontaneously after a few hours ? Do you find any noticable movement ( twitching)in the lower lid of the left eye ?

Customer:

Pulsation sounds right.

Dr. A.S. Desai :

Ok

Customer:

Vision is normal ( I do wear glasses). The throbbing for the most part seems to happen at night. Once in a while during the day. I do not notice any twitching or other eye movement.

Dr. A.S. Desai :

Thank you for all the answers. Final question- Do you have a history of hypertension? Does the pulsation behind the eye feel rhythmic with the heart beat?

Customer:

I do have high blood pressure, for which I take Toprol. I do not know if the pulsation is rythmic with the heart beat.

Dr. A.S. Desai :

There could have been many conditions for pain behind the eye but you have mentioned only pulsation or throbbing sensation to be present. One of the causes could be acephalgic migraine. In this condition there are symptoms of migraine but no headache or pain. This occurs due to changes in the blood vessels in the brain. The other possibility is that of allergic sinusitis. Congestion in the sinus can cause throbbing sensation. The human eye is surrounded on all four sides by four sinuses. Thus sinusitis is one of the most common causes for retrobulbar ( behind the eye) throbbing. Another possibility is that of transmission of the normal pulsation from blood vessels behind the eye due to raised blood pressure.

Customer:

Thank you, XXXXX XXXXX You have given me several topics to discuss with my doctors on Monday.

Dr. A.S. Desai :

You are most welcome! Hope you get relief soon!

Dr. A.S. Desai :

If you need more help, please use the reply tab to continue our conversation. If you do not require further assistance, kindly rate my service.



Thank you and best wishes.



It was a pleasure to have answered this question.

Views expressed are for information purpose only and cannot substitute a visit to an ophthalmologist

Customer:

I am the wife of Ron. I am adding some significant information that he failed to provide due to his middle of the night inquiry. Ron has obstructive sleep apnea (cause unknown) and central sleep apnea (M.S.). He has been wearing a C-pap breathing machine for several years with no problem.

Customer:

Hit the wrong button, so I am continuing: He visited a cardiologist who said this is unrelated to blood pressure. He has had teeth checked out-no problem there. We have been to Bascom Palmer Eye Institute twice. He does have an eye problem related to his MS-Nystagmus where the eye shakes when looking to the side-both eyes. He has severe Trigeminal Neuralgia on the same left side, manifesting itself in severe pain in the tooth (no dental problems exist) when he chews, swallows, talks, etc. He had an MRI, but not a Fiesta MRI (which we recently heard about given at Johns Hopkins Hospital). Nothing has shown up in the MRI; however, his Neurologist said the MS could be in the root of the nerve where it may be related to the MS. He is now trying the second medicine for Trigeminal Neuralgia. Can this throbbing be related to the Trigeminal Neuralgia, the C-pap, the Rhinitus that he does have (which would be a sudden change as he has had this all of his life-takes medicine for it) or something else? He is testing the C-pap as a possible cause by not using it for a week and seeing if the throbbing eases up in any manner. So far, he has slept without it for four day, but the throbbing has not changed? If you go on the website for Johns Hopkins they talk about several procedures to eliminate the Trigeminal Neuralgia and we are wondering if we utilize any of these procedures is it possible this eye problem might be solved simultaneously? Is this throbbing part of an upper type of trigeminal neuralgia?

Expert:  Dr. A.S. Desai replied 1 year ago.
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Expert:  Dr. A.S. Desai replied 1 year ago.
Hello,

Thanks for the additional information.

Obstructive sleep apnea can get worsened by associated allergies or sinusitis. But sleep apnea probably would not have caused the pulsating sensation behind the eye. It could be due to sinusitis as explained earlier or due to pulsations from eye blood vessels ( but this would have been felt in both eyes). If he has not been seen by an ENT( ear, nose ,throat) specialist then I guess it would help to do so. He can try using Tablet.Sinarest, 1 tablet at bedtime would relieve congestion in the sinuses and help to reduce the throbbing sensation.

Regards

Dr.A.S.Desai
Customer: replied 1 year ago.

My husband was hospitalized last night with screaming pain and sobbing from it. He also was unable to eat anything other than yogurt in the morning and the evening.We went to the emergency room and he had a Cat Scan-no trouble with sinuses. He stopped using the C-pap 5 nights ago, but the throbbing (no pain) continued off and on with it now occurring during the day occasionally as well. He had a visit from the ENT and they found nothing other than some calsification in the lower mandible on the opposite side of the face. They have ruled out sinuses. He stopped taking theoxy-Carbamazapine and his neurologist went back to precribing the carbamazapine and added Neuronin (Gabapentin). He has on again off again severe pain even when talking or swallowing. Today it eased up some of the time and that was primarily due to his keeping food on the right side of his mouth when he chewed.


 


He was also evaluated by physical therapy as he has some weakness in his left leg (I see him sitting with his left foot turned sideways all the time). They are trying to see if he meets the criteria to go into a rehabilitation facility of intensive therapy to help him balance and walk-3 hours a day.


 


His neurologist discouraged us the past few days from going to Johns Hopkins Hospital because he said they treated Trigeminal Neuralgia, but not MS patients, without checking them out. It turns out that they treat mostly MS patients. We intend to get an appointment there once his pain has stabilized, his physical therapy and his medications are the correct ones for the time being. I cannot take him on a plane yelling away and unable to eat or walk without falling.


 


His neurologist also aid he never heard of someone having Trigeminal Neuralgia behind the eye at different times than the TG in his jaw. The real question here is can the throbbing be the TG? Do they have to occur in both places at the same time? How do you determine if these are migraines without pain?...and there is no pain, just pressure and what do you do for the eye portion? How do you determine which it is migraine of TG? I probably will not be home much but will try to read your advice as soon as possible.

Expert:  Dr. A.S. Desai replied 1 year ago.
Hello Mrs.Ron,

Thank you for such a detailed information and I truly appreciate your patience in this situation. First of all I have not come across any individual with throbbing behind the eye due to trigeminal neuralgia. Involvement of the ophthalmic branch of the trigeminal nerve is very rare and if at all involved , would have caused pain in the eye. A CT scan might not be able to detect changes in the blood vessels. I cannot say this utmost surety but a contrast MRI scan could throw more light. Phlebitis (inflammation of the veins) can cause such throbbong or pain.

If the throbbing is due to Trigeminal neuralgia, it would cause pain at both sites together. Migraine is a diagnosis of exclusion and is diagnosed after all possible causes have been ruled out.

I guess the given treatment with carbemazapine and gabapentin should give him relief from the pain due to trigeminal neuralgia. If the throbbing is indeed due to Trigeminal neuralgia then he must begin to get relief.

Other possible causes of throbbing behind the eye are practically ruled out as the CT scan was found to be normal.
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2126
Experience: MS Ophthalmology with 11 years of surgical expereince
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