Intense ocular pain

[hoomer]

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Hi everyone,
today i saw a patient who attended the emergency room because of ocular pain.
She had phaco surgery in that (left eye) in 2006, which went without complications. Today the only complaint was and intensive ocular pain, located supra-nasaly and that irradiated to the temporal frontal area. She revealed intense pain on light/moderate ocular pressure on that area. Besides that she revealed no other symptoms (lacimation, red eye, burning, itching,...). The ocular examination revealed no anormality (conjunctiva, sclera, cornea, IOP, anterior chamber,...).
The patient said the pain occured about 3 times a day and dissapeared spontaneously after a few minutes.

P.S- interestingly i saw the same patient two weeks ago with the same complaint. But at that time she had meibomain foam on the lower eyelid and obstruction of of a superior nasal meibomian gland. But even at that time the pain was when i aplied pressure on the sclera and not the superior eyelid. I medicated her with Antibiotic+anti-inflamatory ointment and warm compresses followed with an eyelid masssaga. Today she told me that during the time she did the massages the pain didnt occur.

Any suggestions what this may be????
I told her to do the warm compresses and the massage again and i would see her in 10 days again. but i have no idea what i'll say to her if she still experiences pain at that time.

Thanks alot

 

[MedEye]

I suggest obtaining a CT scan of the frontal sinuses and orbits.

 

[Wolverine98]

How old is she?
If she's old enough, I'd think about getting a CBC, ESR, and CRP. While GCA more typically presents with an aching pain, it can be quite intense for some patients, and it has a way of presenting itself in a lot of different ways.

 

[V05]

You may want to consider sinusitis which can sometimes present with ocular and/or periocular pain/pressure, especially given her symptoms seem to come and go. The CT scan suggested above may help with the diagnosis.

 

[Jokestr]

I agree with the above, however if you have already done a thorough workup I always consider secondary gain as a possibility in things that don't make sense. Does the patient have fibromyalgia, or is she on 3 psych meds? Has she asked you to fill out disability papers yet? Just a thought