In 1984, Jeanette Simpson-Edwards was diagnosed with glaucoma at age 31. An ophthalmologist told Simpson that prescription eye drops should help resolve the condition without causing any damage to her vision. Not noticing any vision problems, Simpson says she often neglected using the drops.
Thirteen years later in 1997, still symptom-free, she saw an optometrist for eyeglasses. The optometrist noticed that the untreated glaucoma had caused Simpson’s optic nerve to deteriorate. Simpson began to use the eye drops again, but symptoms of the glaucoma still didn’t appear until 2008—a full 24 years after her initial diagnosis. “Suddenly I wondered why I was bumping into things and running into curbs,” Simpson recalls.
Today, Simpson, who lives in Noblesville, Ind., has lost parts of her peripheral vision and has undergone laser treatments to reduce swelling and pain in her eyes. She has regular headaches because her eyes tire quickly as she struggles to focus beyond the blurring.
Though many people experience both headache and eye pain, it is often unclear whether the two conditions are directly linked. Following are three conditions that can cause vision problems and head pain: glaucoma, pituitary apoplexy and giant cell arteritis. Evaluation by a medical specialist can reveal these conditions early, before headaches worsen and vision deteriorates.
Glaucoma and Headache
In a normal eye, the fluid behind the iris is able to enter and exit as it needs. With glaucoma, that fluid can be blocked, creating a build-up of pressure in the eye that damages the optic nerve and causes pain. If left unchecked, it can cause vision loss, blindness and headaches.
There are four types of glaucoma:
- Chronic Open-Angle Glaucoma: This type of glaucoma is the most common and involves a slow build-up of pressure over time. That slow increase, combined with a lack of symptoms, often means that the patient doesn’t notice a problem until the damage has already been done, notes the National Institutes of Health (NIH) in PubMed Health.
Despite a lack of symptoms, a routine eye exam could reveal the condition, as was the case for Simpson. By dilating the pupils and using a gonioscopy (a mirrored prism used to view the inner workings of the eye, not generally used unless the physician suspects glaucoma), or through laser scanning images, an ophthalmologist should be able to make the diagnosis. While it can’t be cured, open-angle glaucoma can be managed through the use of eye drops and medication to lower eye pressure.
If medication cannot be tolerated or is ineffective, laser therapy or surgery may be an option, says Joel S. Schuman, MD, FACS, Eye & Ear Foundation professor and chairman at the University of Pittsburgh Department of Ophthalmology.
- Acute Angle-Closure Glaucoma: This type of glaucoma comes on quickly and severely and signals a medical emergency, says Brian Samuels, MD, PhD, assistant professor of ophthalmology and a glaucoma specialist at the Eugene and Marilyn Glick Eye Institute at the Indiana University School of Medicine in Indianapolis, Ind. The drainage angle in the eye suddenly becomes blocked. In this case, symptoms do appear and often worsen over time. These may include nausea, severe pain in or around one eye, cloudy vision and red eye.
This last symptom may or may not have to be present for glaucoma to be diagnosed. Researchers wrote in the Oct. 1998 issue of the journal Headache that it is possible to have glaucoma without redness. They cited three cases in which patients were diagnosed with headaches and migraines that lasted for at least a year. All three patients had “white eye,” or a normal look to the eye without any redness. With the use of a gonioscopy, glaucoma was discovered in all three instances.
To make diagnosis more complicated, acute angle-closure glaucoma can be confused with cluster headache, which also involves head pain (usually at night) and redness. In one case mentioned in a 1991 issue of the Indian Journal of Ophthalmology, a 47-year-old man experienced severe pain around the left eye, watering of the eye and redness. He was misdiagnosed with acute angle-closure glaucoma but later learned he had really been experiencing cluster headaches.
To establish a proper diagnosis quickly, ophthalmologists typically measure the actual intraocular pressure of the eye and continue to measure the pressure until it has dropped, according to The Glaucoma Foundation.
Once diagnosed, treatment usually involves medication to prepare the eye for surgery. Typically surgery can be performed with laser therapy (called iridotomy). In angle-closure glaucoma, the laser creates a hole in the iris so the iris can fall back to its normal position and relieve the blockage of the drain of the eye, Dr. Schuman says. That allows the fluid to drain more easily from the eye into the blood stream. Once the block is released, the glaucoma and headaches should go away.
- Congenital Glaucoma: This form of glaucoma involves abnormal eye development. As such, it?is usually seen in babies and is inherited. As with acute angle-closure glaucoma, redness and cloudiness of the eye itself can signal a problem, as can sensitivity to light and tearing.
Eye drops generally aren’t advised here. Instead, congenital glaucoma is treated with eye surgery. According to the NIH, babies “do well” when surgery is done early.
- Secondary Glaucoma: This type of glaucoma is the result of some other condition, which might include eye disease or trauma. That means an event could cause glaucoma, which then could cause head pain. To stop the domino effect, it is necessary to start by treating the underlying condition.
Pituitary Apoplexy and Headache
While some headaches are caused directly by an eye condition, other headaches appear alongside vision problems. This is the case for pituitary apoplexy (also known as a pituitary infarction), which involves the death of tissue in the pituitary gland. In most cases, this condition is the result of a noncancerous tumor in the pituitary gland that spontaneously bleeds out or hemorrhages, Dr. Samuels says.
People with this condition may experience paralysis of the eye muscles, which can lead to double vision. Researchers wrote in the March 2007 issue of the journal Headache that pituitary apoplexy can be accompanied by a sudden, sharp “thunderclap headache,” named for its impact and severity. Unfortunately, researchers add, diagnosis based on the thunderclap headache alone is tough because that type of headache can be symptomatic of any number of conditions, including brain aneurysm.
To make things more complicated, researchers in the Jan. 2004 issue of the journal Headache revealed that pituitary apoplexy is often misdiagnosed as meningitis. For this reason, the researchers say it is important for anyone who presents with these symptoms to get a magnetic resonance imaging (MRI) scan of the brain to determine the true cause.
Researchers in the meningitis study wrote that pituitary apoplexy is rare but life threatening, adding that rapid treatment is necessary and usually involves administration of high-dose corticosteroid (e.g., cortisone, prednisone) and surgery to remove the tumor.
Giant Cell Arteritis and Headache
Similar to pituitary apoplexy, giant cell arteritis (GCA) is an emergency condition that, if left untreated, can cause headache, vision problems or even stroke, Dr. Samuels warns. Specifically, the condition involves an inflammation of the lining of the blood vessels in the brain. While the cause of this inflammation is unknown, it is suspected that it may be the result of an immune response gone wrong, notes the NIH.
People with GCA are usually older than 50. They may experience a new onset headache that is throbbing in nature, pain in the jaw and visual symptoms including blurred or double vision. Unfortunately, these symptoms also mimic tension-type headaches, migraine and cluster headaches. A blood test or biopsy can help a physician make a proper diagnosis. Administration of oral or intravenous corticosteroids can treat the problem as well as relieve the headaches caused by this condition, Dr. Schuman says.
In each of the eye-related conditions noted here, a proper diagnosis is vital and a plan to treat the underlying cause can help to relieve both the eye problems and the accompanying headaches. Simpson now recognizes that if she had followed her treatment plan, she likely wouldn’t be facing her current vision and headache issues. “My advice to people is to stay on your treatment and don’t miss appointments with your doctor,” she says. “If you don’t follow your treatment plan, it will only get worse.”
Not All Eye Conditions Are Emergencies
Inflammation, dryness, bleeding and straining aren’t always emergencies. But if they aren’t addressed, they could trigger painful headaches.
Inflammation: Uveitis, or inflammation of the eye, is frequently mysterious in origin. It may be the result of a virus, bacteria, parasite or inflammatory disease. This leads to swelling and irritation of the uvea, the middle layer of the eye. The inflammation can cause blurred vision, light sensitivity, redness and headaches. Treatment for uveitis typically includes eye drops or the topical steroid prednisolone acetate (e.g., Pred Forte® or Omnipred®), which is applied four times a day or more. treating the inflammation can relieve the headache, says Joel s. Schuman, MD, FACS, Eye & Ear Foundation professor and chairman at the University of Pittsburgh Department of Ophthalmology. Even with treatment, he warns that the pain and inflammation may take weeks to resolve, depending on the cause. Still, it is important to stick with treatment; untreated uveitis could lead to glaucoma, cataracts (clouding of the lens) and vision loss.
Dry Eye: “When people complain about pain in both eyes, a common cause is dry eye,” says Deborah I. Friedman, MD, MPH, professor of neurology, neuro-therapeutics and ophthalmology and director of the Headache and Facial Pain program at the University of Texas Southwestern Medical Center in Dallas. Symptoms of dry eye include eye pain, burning, itching, redness, blurred vision and the feeling of having sand in your eyes. Such symptoms could be the result of tear deficiency, low humidity in the surrounding environment, contact lens use, medication side effects, or a more serious medical condition such as lupus (a chronic inflammatory disease) or thyroid disease. When it comes to relief for dry eye, Dr. Friedman says “you need lubrication, not ibuprofen.” An ophthalmologist will typically recommend using artificial tears frequently throughout the day. Dr. Friedman says to avoid over-the-counter eye drops containing naphazoline (e.g., Clear Eyes®). “Naphazoline gets the red out, but it can cause rebound redness once the product wears off, leading users to become dependent on the medication over time,” she says. “That’s just counterproductive.” For more severe cases, cyclosporine ophthalmic drops (e.g., Restasis®) are prescribed. In extreme cases, the physician may opt to plug the tear duct in order to reduce drainage of tears and keep the eye lubricated. Once the eye is properly lubricated, the pain should be relieved.
Bleeding: Bleeding in the eye can be caused by blunt trauma to the eye, penetration of the eye or, rarely, cancer or inflammation. Bleeding can raise the level of pressure in the eye that can lead to eye pain, blurred vision and headaches. “The best course of action is to wait it out,” Dr. Schuman says. “Unless it’s a massive hemorrhage, the eye pressure is high or the blood is staining the tissues of the eye, the eye tissue will usually absorb the blood on its own.” If the hemorrhage is severe, the physician may opt to drain the blood surgically. In the meantime, drops of atropine (e.g., Isopto Atropine®) and/or steroids can be used to treat the pain and inflammation. Patients should not take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to treat this condition, as these medications can promote bleeding.
Eyestrain: Often eye pain and headaches are simply the result of eyestrain, a sign that a patient may need glasses or a stronger eyeglass prescription. Eyestrain headaches usually occur after periods of reading or at the end of a workday spent focusing on a computer screen. “When a patient is suffering from eyestrain, a change in eyeglass prescription will often solve the problem,” Dr. Schuman says. “If a new prescription doesn’t fix it, this may indicate the presence of some other eye problem; for example, difficulty reading and eyestrain can be symptoms of a cataract, which could be cured with surgery.”
A special thank you to Frederick Scelzo, MD, Evanston, Ill., for his contributions to this piece.
