Painful eyes with normal exam - Revision history

Danbot: Expand: structured differential by category, IOP and ESR pearls, high-risk diagnoses

2026-03-21T01:45:50Z

Expand: structured differential by category, IOP and ESR pearls, high-risk diagnoses

← Older revision		Revision as of 01:45, 21 March 2026
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	==Background==		==Background==
	[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]		[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
	*~~This page describes~~ a ~~general approach~~ to ~~the complaint of painful eyes with a normal exam~~		*Eye pain with an unremarkable external exam and normal slit-lamp findings poses a diagnostic challenge
			*Key concern: must rule out sight- and life-threatening conditions that may not show early external signs
			*'''High-risk diagnoses to consider:''' [[optic neuritis]], [[temporal arteritis]], [[acute angle closure glaucoma]] (early), posterior [[scleritis]], ocular ischemic syndrome

	==Clinical Features==		==Clinical Features==
	*Normal eye exam		*Normal external eye exam (no injection, no discharge, no corneal findings)
			*Patient reports significant eye pain, periorbital pain, or retrobulbar pain
			*May have associated symptoms guiding diagnosis (see below)

	==Differential Diagnosis==		==Differential Diagnosis==
	*Ocular ~~ischemia~~		===Ocular/Orbital===
	**Carotid disease		*[[Optic neuritis]] — pain with eye movement, decreased visual acuity, afferent pupillary defect
	*[[Optic neuritis]]		*Posterior [[scleritis]] — deep aching pain, may have decreased VA; scleral thickening on B-scan US
	*[[~~Temporal arteritis~~]]		*[[Acute angle closure glaucoma]] (early) — elevated IOP may be only finding before conjunctival injection develops
	*[[~~Sinusitis~~]]		*Ocular ischemic syndrome — dull ache, carotid disease, may have low IOP
	*~~Neuralgia~~
	**[[~~Shingles~~]]		===Referred Pain===
	*[[Migraine]]		*[[Sinusitis]] — frontal/maxillary tenderness, nasal congestion, worse with bending
	*[[DM]]		*[[Temporal arteritis]] — age >50, scalp tenderness, jaw claudication, elevated ESR/CRP
			*[[Migraine]] or [[cluster headache]] — headache history, associated aura or autonomic symptoms
			*Trigeminal neuralgia — lancinating pain in V1 distribution
			*[[Shingles]] (herpes zoster ophthalmicus) — may precede rash by days (prodromal pain)

			===Systemic===
			*Diabetic cranial neuropathy (CN III, IV, or VI)

	==Evaluation==		==Evaluation==
			*Complete [[eye exam]]: visual acuity, pupil exam (APD?), IOP, slit-lamp, dilated fundoscopy
			*'''IOP measurement''' — critical to rule out early angle closure
			*'''ESR and CRP''' if age >50 or concern for [[temporal arteritis]]
			*Consider CT/MRI orbits if orbital or retrobulbar process suspected
			*MRI brain/orbits with contrast if [[optic neuritis]] suspected

	==Management==		==Management==
			*Treat underlying condition
			*If no diagnosis after thorough workup: ophthalmology follow-up within 24-48 hours

	==Disposition==		==Disposition==
			*Urgent ophthalmology referral for decreased visual acuity, elevated IOP, or APD
			*Emergent workup for suspected [[temporal arteritis]] (ESR/CRP, start empiric steroids pending biopsy)

	==See Also==		==See Also==
	{{Eye algorithms}}		{{Eye algorithms}}

	~~==External Links==~~

	==References==		==References==
	<references/>		<references/>


	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
	[[Category:Symptoms]]		[[Category:Symptoms]]

Rossdonaldson1 at 18:15, 4 February 2026

2026-02-04T18:15:35Z

← Older revision		Revision as of 18:15, 4 February 2026
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			==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]
			*This page describes a general approach to the complaint of painful eyes with a normal exam

			==Clinical Features==
			*Normal eye exam

	==Differential Diagnosis==		==Differential Diagnosis==
	*Ocular ischemia		*Ocular ischemia
Line 9:		Line 16:
	*[[Migraine]]		*[[Migraine]]
	*[[DM]]		*[[DM]]

			==Evaluation==

			==Management==

			==Disposition==

	==See Also==		==See Also==
	{{Eye algorithms}}		{{Eye algorithms}}

			==External Links==

	==References==		==References==

ClaireLewis at 21:29, 6 October 2019

2019-10-06T21:29:34Z

← Older revision		Revision as of 21:29, 6 October 2019
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	*[[Optic neuritis]]		*[[Optic neuritis]]
	*[[Temporal arteritis]]		*[[Temporal arteritis]]
	*Sinusitis		*[[Sinusitis]]
	*Neuralgia		*Neuralgia
	**[[Shingles]]		**[[Shingles]]
	*[[Migraine]]		*[[Migraine]]
	*[[DM]]		*[[DM]]
	**CN 3/4/6 palsy

	==See Also==		==See Also==

Rossdonaldson1: /* See Also */

2019-04-03T05:11:41Z

Neil.m.young at 19:52, 21 November 2016

2016-11-21T19:52:45Z

← Older revision		Revision as of 19:52, 21 November 2016
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	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]
			[[Category:Symptoms]]

Rossdonaldson1: Text replacement - "==DDX==" to "==Differential Diagnosis=="

2016-10-04T17:00:46Z

Text replacement - "==DDX==" to "==Differential Diagnosis=="

← Older revision		Revision as of 17:00, 4 October 2016
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	==~~DDX~~==		==Differential Diagnosis==
	*Ocular ischemia		*Ocular ischemia
	**Carotid disease		**Carotid disease

Neil.m.young: Text replacement - "==Source==" to "==References== "

2016-06-26T02:17:37Z

Text replacement - "==Source==" to "==References== <references/>"

← Older revision		Revision as of 02:17, 26 June 2016
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	*[[Eye Algorithms (Main)]]		*[[Eye Algorithms (Main)]]

	==~~Source~~==		==References==
			<references/>


	[[Category:Ophthalmology]]		[[Category:Ophthalmology]]

Ostermayer: Text replacement - "Category:Ophtho" to "Category:Ophthalmology"

2016-03-22T15:43:27Z

Text replacement - "Category:Ophtho" to "Category:Ophthalmology"

← Older revision		Revision as of 15:43, 22 March 2016
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	[[Category:~~Ophtho~~]]		[[Category:Ophthalmology]]

Rossdonaldson1: /* DDX */

2014-10-13T17:34:27Z

DDX

← Older revision		Revision as of 17:34, 13 October 2014
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	==DDX==		==DDX==
	#Ocular ~~Ischemia: 2/2 carotid dz, carotid bruits, retinal hemorrhages, give ASA~~		*Ocular ischemia
	#Optic ~~Neuritis: APD, reduced color vision~~		**Carotid disease
	#Temporal ~~Arteritis:check esr/crp~~		*[[Optic neuritis]]
	#Sinusitis		*[[Temporal arteritis]]
	#Neuralgia~~: shingles~~		*Sinusitis
	#Migraine		*Neuralgia
	#DM: CN 3/4/6 palsy		**[[Shingles]]
			*[[Migraine]]
	~~^CN 3 palsy: dilated pupil, ptosis (droopy eyelid) w/ HA, must consider cerebral aneurysm~~		*[[DM]]
			**CN 3/4/6 palsy

	==See Also==		==See Also==

Rossdonaldson1: /* Source */

2014-10-13T17:32:41Z

Source

← Older revision		Revision as of 17:32, 13 October 2014
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	^CN 3 palsy: dilated pupil, ptosis (droopy eyelid) w/ HA, must consider cerebral aneurysm		^CN 3 palsy: dilated pupil, ptosis (droopy eyelid) w/ HA, must consider cerebral aneurysm

			==See Also==
			*[[Eye Algorithms (Main)]]

	==Source==		==Source==
	~~Adapted from Pani~~

	[[Category:Ophtho]]		[[Category:Ophtho]]

← Older revision		Revision as of 05:11, 3 April 2019
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	==See Also==		==See Also==
	*[[Eye ~~Algorithms (Main)]]~~		{{Eye algorithms}}

	==References==		==References==