Headache and eye diseases by alicejenny

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									Headache and eye
    diseases
   Dr.Suseela.B.Nair
“ RED FLAG “ Headaches
• Headache with altered mental status
• Headache with focal neurological
  findings
• Headache with papilledema
• Headache with meningeal signs
• The “worst headache of life”
• Headache in the patient with AIDS
 Headache Presentations
• Patient with a history headaches with
  the same headache
• Patient with history of headaches
  and different headache
• Patient with the first time severe
  headache
       The Deadly Dozen
•   Subarachnoid headache
•   Acute closure glaucoma
•   Carbon monoxide poisoning
•   Preeclampsia
•   Hypertensive encephalopathy
•   Meningitis / encephalitis
•   Temporal arteritis
The Deadly Dozen (cont)
•   Cavernous sinus thrombosis
•   Mass lesion/ tumor/ abscess
•   Cerebral vascular accident
•   Epidural/subdural
•   Hydrocephalus
Papilledema
           Glaucoma
      Acute Angle Closure
• anterior chamber outflow tract
  blocked by iris root
• accumulation aqueous humor in
  posterior chamber – IOP
• optic nerve and retinal ischemia
         Glaucoma
    Physical Examination
• red eye
• non-reactive, midposition pupil
• pupil may have irregular margins
• “hazy” or “steamy” cornea
• increased intraocular pressure,
  usually greater than 50 mmHg
• shallow anterior chamber
   Intraocular Pressure
      Measurement
• Palpation
• Schiotz tonometer, Goldman
  applanation tonometer, Tonopen
• 10-20 mmHg normal
• 20-27 mmHg with visual loss - treat
• > 28 mmHg - treat
           Glaucoma
          Treatment
• Reduce pressure
      1. Topical agents - B-blockers
      2. Oral agents - Acetozolamide
      3. Miotics - Pilocarpine
      4. IV agents - Acetozolamide,
                Mannitol
• Ophthalmologist consult - peripheral
  iridectomy
    Temporal Arteritis
• Generalized vasculitis unknown
  etiology
• Visual loss most common sequelae
• Onset usually after age 50
• Females affected 4 times more than
  males
      Temporal Arteritis
      Historical Features
• Headache - dull onset, intensifies to
  burning, jabbing pain. Localized over
  temporal arteries.
• Jaw claudication
• Visual symptoms - blindness without
  warning
• Systemic symptoms
      Temporal Arteritis
     Physical Examination
• Low grade fever
• Scalp tenderness prominent
• Temporal artery tenderness
                     AION




Retinal
Vascular occlusion
        Temporal Arteritis
          Management
•   ESR elevated - often > 100mm/hr
•   Anemia and leukocytosis
•   Temporal artery biopsy
•   Prednisone 60-80 mg/day
       Hypertensive
      Encephalopathy
• Usually occurs in patients over age
  40
• Results from cerebral hyperperfusion
  from loss autoregulatory mechanisms
• Symptoms improve with lowering the
  blood pressure
  HTN Encephalopathy
  Historical Features
• History of noncompliance
• Symptoms progressive over days
• Headache - generalized, non
  throbbing
• Nausea and vomiting
• Confusion to coma
• Blurred vision
     HTN Encephalopathy
     Physical Examination
•   Diastolic BP > 140 mmHg
•   Altered mental status
•   Seizures
•   Papilledema
•   Retinal hemorrhages
•   May have focal neurological findings
      Ocular Ischemic
        Syndrome
• Caused by atherosclerotic changes in
  carotid
• Elderly individuals
• Vague headache
• Vision loss may be mild to severe, may
  be attributed to other causes like
  cataract
• Slit lamp evaluation:
   anterior chamber flare and cells
  (Ischemic iritis)
    cataract
    rubeosis iridis
      Ocular Ischemic
        Syndrome
• Fundoscopy:
  mid peripheral retinal hemorrhages
  venous dilatation
  disc pallor
• IOP may be low even with
 closed angles due to decreased
 ciliary body perfusion
Convergence
insufficiency
Herpes zoster ophthalmicus
 (Pre herpetic neuralgia)
Accommodative spasm
Uncorrected refractive
       errors
Presbyopia
Computer vision syndrome
MIGRAINE
Cluster head ache
           Others…
• Anterior uveitis
• Primary open angle glaucoma /
  secondary glaucoma
• Optic neuritis
• Orbital inflammatory disease
• Scleritis
• Drugs eg: Pilocarpine

								
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