Pain in and around

Definition, types, causes of pain.
ocular strain, stress,
orthoptic problems- FI, AI, CI
it is covered every aspect of ocular pain in around eye or within an eye

1. Pain in and around eye
Presenter
Kapil Gautam
Institute of medicine, MMC, KTM, Nepal

2. Presentation layout
▪Pain –Definition
-Types
▪Cause of pain in eye –Diseases
-Pathophysiology
-Symptoms
▪Cause of pain in around eye

3. pain
An unpleasant sensory and emotional experience
associated with actual and potential tissue
damage (American Pain Society [APS],2003;Gordon,2002)
Physical and emotional experience, not all in the
body or all in the mind. It is in response to actual or
potential tissue damage, so there may not be
abnormal lab or radiographic reports despite real
pain.
Pain is described in terms of such damage.
BUT, it isn’t necessary that every damage tissue
give arise pain, At least not in initial phage
▪ E.g. Acute Conjunctivitis

4. Basic classification of Pain
DURATION
Acute pain-lasts only through the expected
recovery period whether it has a sudden or slow
onset and regardless of intensity.
Chronic pain-is prolonged, usually recurring or
persisting over months or longer, and interferes
with functioning.
-Mild to severe,
-Constant or recurring without anticipated or
predictable end and a duration of greaterthan 6
months. (Ackley&Ladwig, 2006)

5. Classification
Pain
Nociceptive
Neuropathic
Inflammatory

6. NOCICEPTIVE PAIN
▪Nociceptive pain -arises from a stimulation of specific
pain receptors and is a normal response to potential
damage or injury of tissues such as skin, muscles,
visceral organs, joints, tendons, or bones. We all
experience this type of pain from time to time it tends
to resolve in a reasonable amount of time.
▪Somatic-muscles, joints, tendons, ligaments
bones or skin pain
This pain is often localized
▪Visceral -hollow organs and smooth muscle and
may have cramping, throbbing, or aching quality
Often associated with feeling sick

7. NEUROPATHIC PAIN
-Pain initiated or caused by a problem with the
signals from the nerves
-Cause can be a number of reasons but it is
often following an injury or disease of the
nervous system.
Eg. HZO
▪The nature of neuropathic pain ranges from
deficits perceived as numbness to
hypersensitivity (hyperalgesia or allodynia), and
to paresthesia’s such as tingling.

8. NATURE OF NEUROPATHIC PAIN
Allodynia-This means that the pain comes on, or
gets worse, with a touch or stimulus that would
not normally cause pain.
Eg. Recurrent corneal erosion
Hyperalgesia-This means that you get severe pain
from a stimulus or touch that would normally
cause only slight discomfort.
Eg. GCA
Paresthesia-This means that you get unpleasant
or painful feelings even when there is nothing
touching you, and no stimulus. For example,
you may have painful pins and needles, or
electric shock-like sensations.

9. INFLAMMATORY PAIN
▪The body responds to damage, injury or any
underlying cause by activating pain pathways to
produce inflammation.
▪Although long term inflammation can do a lot of
damage, initially its role is protective
Examples : Stye, Uveitis, Appendicitis,
Rheumatoid arthritis etc.

10. Classification
(Based On Intensity Of Pain)
Classified using a standard 0 (no pain) to 10 (worst
possible pain) scale
Mild pain-rating of 1-3. Moderate pain-rating of 4-6
Severe pain-reaching 7-10 and is associated with
worst outcome. Eg. Temporal arteritis

11. Referred Pain
-Painful sensation in a body region distant
from the true source of pain
-Occurs in an area supplied by the same
neuro-segment as the involved organ
-Pain is referred to a structure that is
developed from same embryonic segment
or dermatome according to Dermatomal
rule

12. Ocular diseases a/w
pain

13. Eyelid a/w pain
▪External Hordeolum(Stye)
An acute suppurative inflammation of lash follicle and its
associated glands of Zeis or Moll
Symptoms-include acute pain associated with swelling of
lid, mild watering and photophobia
Internal Hordeolum
-A suppurative inflammation of the Meibomian gland
associated with blockage of the duct
Symptoms -Include acute pain associated with swelling of
the lid, watering and photophobia
The symptoms are similar to external Hordeolum (Chalazion),
Except that pain is more intense in internal Hordeolum

14. Trichiasis
Misdirection of cilia which rub against the eye ball
with normal position of the lid margin
Symptoms-Include FB sensation, photophobia,
irritation, lacrimation along with pain
NOTE-Not an agent BUT abraded cornea causes pain
Entropion
Refer to inward rolling and rotation of the lid
margin toward globe
Symptomsdue to rubbing of cilia against the cornea
and conjunctiva and are thus similar to trichiasis

15. Eyebrow pain and swelling
▪Monocular
Pain may be cause by local infection-
Sinus disease, Shingles.
▪Binocular
Involved may be allergy, Thyroid disease,
Infection, Seborrhea, Rosacea

16. Conjunctiva
-Conjunctival pain may due to involve
Bacterial/viral/chlamydial conjunctivitis, Xerosis,
Foreign body, Dry eye etc.
-In most cases conjunctivitis don’t arise pain, until
corneal involvement

17. Type of
conjunctivitis
remark Type
of pain
Bacterial
conjunctivitis
Gonococcal
conjunctivitis
-Quite frequent invade
the normal cornea
+ve
Chlamydial
conjunctivitis
Trachoma Phageof active
trachoma –in corneal
stage-SK, corneal
ulcer
+ve
Viral
conjunctivitis
Acuteherpetic
conjunctivitis
If corneal involvement
(typical dendritic
keratitis)
+ve
EKC Superficialpunctate
keratitis
+ve

18. Scleritis
Scleritis refers to an inflammation of the sclera proper.
It is a comparatively serious disease which may cause
visual impairment and even loss of the eye if treated
inadequately
Histopathological changes are that of a chronic
granulomatous disorder characterized by fibrinoidnecrosis,
destruction of collagen.
Scleritis may be an anterior, posterior, necrotizing, non-
necrotizing with characteristics diffuse or nodular
▪Clinical features are
Pain-deep and boring in character and often wakes the
patient early in the morning
–upon eye movement
Redness, photophobia, lacrimation along with diminution
of vision

19. Cornea
One of the most densely innervated tissue
Density of central corneal nerve endings is estimated
to be around 7000 nerve terminals per square
millimeter
The corneal density of nociceptors in nerve endings is
about 300-600 times that of skin
Ocular neuropathic pain also referred to as corneal
neuropathic pain.
It is frequently accompanied by blurred vision,
congestion andphotophobia

20. 1-Ulcerative keratitis
Define as discontinuation in normal epithelial
surface of cornea associated with necrosis of
the surrounding corneal tissue
Pathologically characterized by oedema and
cellular infiltration
reduced vision
pain in the eye (often sudden)
increased light sensitivity
excessive tearing or discharge from eye
E.g. Bacterial/ fungal keratitis

21. Mycotic corneal ulcer..
1-Feathery Margins
2-Elevated edges
3-Rough Textured
4-Satellite lesions
5-Endothelial plaque

22. 2-Acanthamoba keratitis
Protozoal keratitis
Recently gained importance because of
its increasing incidence
Contact lens wearers using home-made
saline recognized for more of this
infection
Common symptoms are
-FB sensation
-Mild to severe pain
-Blepharospasm

23. Causes of corneal neuropathic pain
1-Chronic ocular neuropathic pain
a-Dry eye syndrome
-Friction during blink can cause
abrasion btw lid and cornea
b-Recurrent corneal erosions
c-Chemical burns
d-Ocular surface neoplasia

24. -Topical-preservatives containing
Benzalkonium chloride
-Systemic-isotretinoin
2-Toxic keratopathy
3-Photokeratitis-occurrence of multiple epithelial
erosion due to the effect of UV (311-290μ)
C/O-severe burning pain
H/O-exposure to UV 4-5 hrs
On fluorescein staining
multiple spots are demonstrated
on both corneas
Photokeratitis

25. Keratoconus
▪A non-inflammatory bilateral(85%) ectatic condition of
cornea in its axial part
▪Complicated keratoconus may be development of
acute hydrops due to rupture of Descemet's membrane
condition may be characterized by
Sudden development
of corneal oedema
a/w mark defective
vision
Pain

26. 4-Trauma
A-Corneal foreign body
-Common FB that can adhere to and become
embedded in the surface of the cornea including
-Concretion
-inorganic grit (sand, tiny stone particles, dust)
Causes
corneal abrasion
corneal laceration

27. B. Corneal Abrasion
▪Abrasion of the corneal epithelium usually caused
by direct trauma
▪Is ascratched cornea, causes very severe pain,
photophobia and watering
▪Deeper abrasions can lead to
a serious eye infection and
even acorneal ulcer if left
untreated

28. C. Corneal Erosion
▪Poor hemi-desmosome attachments between
epithelium Bowman’s membrane due to
previous trauma
▪Patient awakens with
acute pain

29. D. Corneal laceration
-Is a partial-or full –thickness injury of the cornea
-It can also be caused by something striking the eye
with significant force (like a metallic hand tool)
-Corneal laceration is deeper than acorneal abrasion
▪Symptoms are
-intense pain
-reduced VA , photophobia

30. 5-Systemic neuropathies
Diabetes
Small fiber neuropathy
Multiple Sclerosis
Kerato -refractive surgery
Cataract surgery
Corneal transplant surgeries
6-Post-Surgical

31. 7-Infection
-Herpes simplex keratitis
-Herpes zoster keratitis
8-Miscellaneous
-Trigeminal neuralgia
-Fibromyalgia

32. Angle Closure Glaucoma
An attack of acute rise in IOP in patients with
primary angle closure (PAC) may occur due to
pupillary block causing sudden closure of the
angle.
-It is a sight threatening emergency disease
▪Clinical features are
Severe Pain along V nerve distribution (ear,
teeth)
headache, nausea, and vomiting
▪mistaken for migraine because of headache with
coloured haloes

33. Acute anterior uveitis
▪Inflammation of the uveal tissue from iris up to
pars plicata of ciliary body, almost always
present combined Iritis, Iridocyclitis, Anterior
cyclitis
▪Clinically symptoms are
Pain-dull aching throbbing sensation which
is typically worse at night
Along distribution of branch of V nerve
Redness along CCC, photophobia and
blepharospasm, lacrimation and
defective vision
Pain, photophobia and redness are conspicuously
absent in intermediated and posterior uveitis

34. Panophthalmitis
▪An inflammation of the inner structure of
the eyeball i.e., uveal tissue and retina
▪Symptoms are characterized by severe
ocular pain, redness, lacrimation,
photophobia and loss of vision
Endophthalmitis
▪An intense purulent inflammation of the
whole eyeball including the Tenon’s
capsule.
▪Symptoms are characterized by severe
ocular pain, Headache, complete loss
vision, profuse watering, discharge

35. Acute Dacryocystitis
▪An acute suppurative inflammation of the lacrimal
sac, characterized by presence of a painful
swelling in the region of sac
▪Clinical features
1-stage of cellulitis –characterized by a painful
swelling in the region of lacrimal sac
2-stage of lacrimal abscess-continuous
inflammation cause occlusion of the
canaliculi due to oedema
3-stage of fistula formation-if lacrimal abscess
is left unattended,
-Abscess may open up into the nasal cavity
forming an internal fistula

36. Dacryoadenitis
▪Primary inflammation of the gland or
secondary to some local or systemic
infection
▪Clinical features
Painful swelling in the lateral part of
the upper lid
Painful
proptosis

37. Trochleitis
▪Isinflammationof the superior oblique
tendon trochlea apparatus characterized
by localized swelling, tenderness, and
severe pain
local pain,
swelling, and
tenderness,
worsen with upward
gaze in abduction

38. Ocular ischaemic syndrome
▪It refers to a rare condition resulting from
chronic ocular hyperperfusion secondary
to stenosis of carotid artery
▪Symptoms
include loss of vision (progresses
gradually),
Transient black outs
(amaurosis fugax)
▪Pain, ocular or periorbital,
may be complained by
some patients.
Fig-ischaemic optic neuropathy

39. Optic neuritis
▪An inflammatory condition
of the optic nerve
Pain-Dull often cause behind the eye or
pain upon eye movement,
-Vision/ Visual field loss,
-Loss of color vision,
-Flashing lights.

40. Retinoblastoma
▪A common malignant tumour
arising from the neurosensory retina in
one or both eyes
▪Painful red eye presentations-when
retinoblastoma is left untreated during
the quiescent stage, some pts may
present with severe pain, redness, and
watering due to acute sec glaucoma or
apparent intraocular inflammation or
orbital cellulitis

41. Giant Cell Arteritis/Temporal Arteritis
▪Systemic disorder of unknown cause
▪Inflammatory obliterate arteritis involving
branches of the external carotid and
ophthalmic arteries
▪Cause of anterior
ischemic optic neuropathy

42. ▪GCA Symptoms –
–New onset headache
–Scalp tenderness to touch
–Jaw/tongue claudication
–Limb claudication
–Systemic symptoms
–Permanent vision loss: 15%
–Transient vision loss: 20%
–Diplopia: 10%
Hoffman GS, Langord CA, Weyand CM, Goronzy JJ. Inflammatory diseases of blood vessels, 2nd
ed. Wiley-Blackwell, 2012.

43. Ocular a/w
▪Conjunctiva–congestion
▪Cornea-edema, keratitis
▪Anterior chamber-depth, cells and flares
▪Pupil-RAPD ( compressive neuropathy)
dilated ( cerebral aneurysm)

44. Ocular pain a/w headache
1-Migraine headache-Most common type of primary
headache. An estimated 28 million people in the
United States (about 12% of the population) will
experience a migraine headache.
-Common causes of pain behind the eyes is
migraine headaches.
-In the case of a migraine headache, the only
one eye and often is accompanied by pain
elsewhere on the same side of the head.
i-Classic migraine-visual symptoms without the
head pain, may see zigzag lines, shimmering or
colored lights or flashes of light in one side of
vision

45. 2-sinusitis
▪Infection or inflammation of
one or more of the paranasal sinuses
▪Sinusitis is usually preceded by a cold, allergy
attack or irritation from environmental pollutants
▪Major symptoms are Nasal obstruction(most
common symptom), pain tenderness, swelling
and pressure over sinus areas (near the nose,
above the teeth, forehead, around eye),
hyposmia/anosmia, facial congestion and fever

46. 3-Cluster headache-Are a rare type of
primary headache affecting 0.1% of the
population (1 in a 1,000 people).
-causes pain in and around eye
4-Depression / tension headache-
Causes may be anxiety, emotional stress,
depression, and lack of sleep
-pain around the eye are common

47. Intracranial aneurysm
▪-It is possible for an intracranial
aneurysm to cause pain in the trigeminal
distribution without any other
neurological features although these
must be liked for very carefully particular
lid, pupil eye movement or facial sensory
disturbance.
▪Pts with recent severe pain around the
eye should be asked about increased
sensitivity to touch

48. Juvenile idiopathic arthritis (JIA)
▪JIA is an inflammatory disease of the joints that
affects children under the age of 16
Autoimmune disease
Cause inflammation of the joints
▪How does JIA affect the eye?
Some children with JIA will also get
inflammation of the eye.
JIA mainly causes Anterior uveitis
Symptom
Severe pain

49. Thyroid and eye ball pain
Considered an autoimmune disease with orbital
fibroblasts as the primary target of inflammatory
attack and EOM being secondarily involved
The pain most often originates from
Exposure keratitis,
Ocular motility defects,
Optic neuropathy-
Causes direct compression of the nerve
Enlarge rectus muscles at the orbital apex
Manifest as papilloedema or optic atrophy

50. An acute infection of Gasserian ganglion of the fifth cranial
nerve by the VZV
Occurs more commonly in immuno-compromised individuals
The pain of HZO is described as burning, aching,
stabbing, shooting, or throbbing
The pain may precede the skin eruption by days and
persist for more than120 days as post herpetic
neuralgia
Post-herpetic neuralgia may
be difficult to treat but often
responds to gabapentin,
or topical anesthetics
Herpes Zoster Ophthalmicus

51. Dry eyes
▪Per se is not a disease entity, but a symptom
complex occurring as a sequelae to deficiency or
abnormalities of the tear film
▪Causes may Aqueous deficiency or evaporative
dry eye or both
conjunctival signs –mildly congested,
conjunctival Xerosis, and keratinization
Corneal signs-punctate epithelial erosions
Symptoms
irritation, FB sensation, itching
also eye pain, headaches

52. Photophobia
▪Literally meaning fear of light
▪The symptom is best described as discomfort or
pain in the eye due to light exposure
▪It is believed to be caused by a reflex resulting in
histamine release in the iris and ciliary muscles it is
common in inflammatory conditions such as keratitis
and iritis, but also occur in migraine, subarachnoid
hemorrhage and meningitis
▪In particularly albinism(pts) photophobia is more
painful .

53. Bell’s palsy
▪Bell’s palsy is a nerve problem
▪Muscles on one side of face become
weak or paralyzed (damage Facialnerve)
▪Causes are
-Body’s immune system
-Infection from a virus,
-Causing swelling of the facial nerves
▪One eye may not close completely and it may
Irritated
Dye eye syndrome
may have blurry vision

55. Traumatic eye
Pain occurred immediately after grinding metal,
sawing wood, or other activities that might cause
a FB injury.
-Close-globe injury
-Open-globe injury
▪If pts have had recent eye surgery,
includingLASIKand cataract surgery
▪Chemical injuries-due to widespread
sloughing epithelium of cornea/conjunctiva

56. Ecchymosis (Black eye)
▪Bruising around eye due to an injury to the
face/head
▪Loose tissue around the eye swell as fluid
build up
▪By trauma there might cause
hyphema,
corneal abrasion,
cause increase IOP,
loss of vision,
inability to move the eye
along with sever pain

57. Cellulitis
▪Cellulitis is serious because the infection spreads
quickly
▪Cellulitis is often caused by an infection from bacteria
/fungus
▪Other problems that can lead to cellulitis include:
Insect bites
a skin wound (especially on the face)
dental surgery or other surgery of the head
sinus infection
▪What are symptoms of cellulitis?
Bulging eye
Ocular pain
Swelling of the eyelid or tissue around the eye
Red eyelids

58. Preseptal cellulitis Orbital cellulitis
DefinitionRefers to infection of the
subcutaneous tissue
anterior to the orbital
septum
An acuteinfection of the soft tissue of
the orbital behind the orbital septum
Actuallyit isn’t orbital
disease
Orbital diseasemight progress to a
subperiosteal abscess or orbital
abscess
Pain Mild, due to inflammatory
oedema of the eyelids or
periorbital skin
Severe pain
EOM normal Pain increase by movementsof the
eyeball or pressure
VA normal Vision lossand/ or diplopia in
moderated to advanced disease

59. Microvascular Cranial Nerve Palsy(MCNP)
▪Cause of blood flow to certain nerves in head is
blocked
▪Result pts may not be able to move eyes and causes
double vision
▪K/w “diabetic palsy.”
▪Clinical features
–Problems moving eyes
▪Blurry vision & double vision (vertical double vision)
▪Can have pain in or around eye

60. Contact lens induce pain
CL predominantly affect the function of the epithelium
▪CL reduce the direct availability of o2to the epithelium
and shift the metabolism aerobic to anaerobic
Result the CO2increase and acidic % increase
Irritation
Epithelial oedema
In severe cases
-Keratopathy (SPK)
-Corneal ulcer
-Punctated corneal erosion
-Red eye along with severe ocular pain

61. Functional Cause
1-Eye Strain: Ciliary Muscle Stressed, Overworked.
2-Refractive Error:
Un-corrected Astigmatism
Un-corrected Hypermetropia
Un-corrected Presbyopia.
Over Corrected Myopia
Over-Corrected Presbyopia
3-By Spectacles:
Wrong Power in Spectacles, Wrong IPD, Improper
Centration of Glass.

62. 4.Accommodative Anomalies:
E.g. Accommodation insufficiency-Excess reading
in young patient
5.Convergence Anomalies:
E.g. Convergence Insufficiency.
6.Ocular Muscle Problem: Tropia/Phoria.

63. Ocular pain & Refractive Error
▪Myopia, Hyperopia , Astigmatism,
Presbyopiacauses blurred vision
▪The cause of pain associated with vision
problems stems more from our eye and
brain trying to compensate for the disorder
(ocular pain/Headache)
▪Squinting and intense focusing can cause
pain to buildup inside and behind the eye.

64. The diagnostic criteria for pain associated with refractive
errors defined as
▪1. Uncorrected or miscorrected refractive errors such as
hyperopia or astigmatism
▪2. Mild headache in the frontal region and in the eyes
themselves,
▪3. Pain absent on awakening and aggravated by
prolonged visual tasks at the distance or angle where
vision is impaired.
Disappearance of the pain following successful treatment
of the underlying refractive disorder is another important
diagnostic criterion.

65. Myopia
-Asthenopic symptoms occurs in small degree
of myopia due to dissociation between
convergence and accommodation.
Since , myopes need not accommodation for
near vision, so they may develop
convergence weakness and exophoria
and suppression in one eye.

66. Hyperopia
▪patient can only see clearly by contracting the
ciliary muscles, and throughout his waking day
they are in a state of tonic contraction, the
contraction being greater when close work is
done.
▪After prolonged close work these muscles tire,
and the patient finds his sight varying, the type
appearing alternately clear and confused.

67. Astigmatism
▪Ocular pain in young people is more often due
to astigmatism than any other cause, up to 75
per cent in the accommodative types of ocular
headaches.
▪Pain is due to irregular or excessive action of
the internal muscles of the eyeball
▪Varying and unequal contraction of the ciliary
muscle (accommodative effort) ends in ciliary
muscle fatigue, all in the effort to maintain or
gain clear vision, from the confusion of images
common to these eyes.

68. ▪In hyperopic astigmatism, mixed astigmatism,
lastly myopic astigmatism, ocular pain is common,
especially where the eyes are used much, but
quite unusual in the purely spherical myopia.
▪Pain may be over the eyebrows, frontal region, or
back of the head and neck. It may be one-sided,
or it may be diffuse.

69. EOMs weakness
Muscle imbalance is the major alternative diagnosis to
refractive error. Pain may follow excessive, sustained,
extraocular muscle contraction to preserve alignment of the
visual axes and binocular vision.
Ocular muscle imbalance as latent squint and convergence
insufficiency causes ocular pain
Accommodative insufficiency
Lack of fusional capacity also causes ocular pain

70. Ocular pain a/wEOMs weakness
Convergence insufficiency
Divergence insufficiency
Convergence excess
Divergence excess
Fusional Vergence Dysfunction
Basic exophoria
Basic esophoria
Cyclorotatory heterotropias

71. Fusional vergence dysfunction
is a condition where the distance and near
phorias are normal, the AC/A ratio is normal, and
POSITIVE and NEGATIVE fusional vergence
ranges are restricted.
Basic exophoria
is a disorder where tonic vergence is
lowwith a normal AC/A ratio. The exophoria is
similar at distance and near, with decreased
POSITIVE fusional vergence.

72. Fusional Vergence Dysfunction
Eyestrain/pain
Headaches
Decreased comprehension and inability to
concentrate while reading
Excessive tearing
Blurred vision
Symptoms

73. Basic esophoria
is a condition where tonic vergence is high
while the AC/A ratio is normal. There is esophoria BOTH
at distance and near, with reduced NEGATIVE fusional
vergence.
Cyclorotatory heterophorias
are latent rotary displacementsabout an antero-
posterior axis. They may be caused by orbital,
neuromuscular, or innervational factors.
-Less chances of improvement with vision therapy
-Proper prism correction could be relieving factor

74. symptoms
Losing place while reading
Eye fatigue
Reading slowly and skipping lines
Headaches and blurred vision with
near work

75. Accommodation
▪Ciliary muscle contraction, relaxation, and
fatigue could stimulate the pain
▪Produce a dull aching throb, a sharp knife-like
pain, a heavy tired feeling
▪As seen in occipital aches of hyperopic
astigmatism

76. Duane’s classification system
▪Accommodative Insufficiency
▪Ill-sustained Accommodation
▪Paralysis of Accommodation
▪Accommodation Excess
▪Accommodative Infacility

77. Symptoms
Related to the use of the eyes for reading
or the other near tasks.
Blurred vision for near
Headaches
Eyestrains
Reading problems
Fatigue & sleepiness
Pulling sensation around eye

78. Presbyopia
▪In presbyopia there is a loss of elasticity of the
lens, the range of accommodation or focusing is
diminished, and the visual acuity for near work is
interfered
▪Efforts to read or to do fine work at the usual
near point for any length of time are sooner or
later attended by pain due to an early fatigue of
the ciliary muscle & causes unable to contract to
its full extent.
▪Almost 40 per cent of presbyopes suffer from
these focusing headaches or ocular pain

79. Digital eye stress
Excessive use of computer, TV, Smart mobile
phone causes CVS
Due to refractive anomaly involved
Infrequent blinking causing dryness and
tiredness of eyes
Constant and steady body position
Constant change of focus from keyboard to
screen to documents
Headache and dizziness
Different types of gadget, illumination
imbalance, near work syndrome make eye
stress and fatigue

80. Tolosa-Hunt syndrome
▪An idiopathic syndrome characterized by the
formation of granulation tissue in the anterior
cavernous sinus or superior orbital fissure,
producing a painful ophthalmoplegia
▪Paresis of one or more
of the third, fourth
and/or sixth cranial
nerves

81. Unknown that causing eye ball pain
▪Atypical pain-unsatisfactory diagnosis which
does not have specific treatment it is better to use
the term undiagnosed facial pain and ocular pain
▪Some authors conclude that vitamin B12
deficiency should be considered in the differential
diagnosis of ocular neuropathic pain and dry eye
in patients presenting with recalcitrant ocular
neuropathic pain.

82. summary
1-The Pain is biological alarm of impending
or actual tissue damage, pain is essential for
our survival
2. There are a lot of diseases which are
not cause pain still vision threating or
life threating

83. References
▪A. K. Khurana Anatomy and Physiology
▪AAO –Neurophthalmology

84. Thank
you