1 Eye Complaints and Facial Pain SU12
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Transcript of 1 Eye Complaints and Facial Pain SU12
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Eye Complaints / Facial PainThomas R. Bodette, D.C., CCSP
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Visual Dysfunction
Loss of central vision:
Cataracts (most common cause),
Retinal detachment
Loss of peripheral vision:
Glaucoma (buildup of pressure in
anterior chamber before Canal of
Schlemm)
Retinitis Pigmentosa (younger
people, poor night vision, often
present as clumsy or accident-
prone)
Acute loss of vision = Vascular,
traumatic
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Visual Dysfunction
Chronic loss of vision: Macular degeneration
Presbyopia
Flashes of light
Migraine, Vitreoretinal traction
Halos around light:
Glaucoma, corneal disease
Transient loss of vision:
Amaurosis fugax (thrombus inretinal artery, pt describes that a
curtain goes up when thrombus
dissolves)
Multiple sclerosis (30-40 y.o)
Papilledema 3
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Visual Dysfunction
Diplopia (monocular):
Cataracts (unilateral)
Refractive error
Diplopia (binocular): Vascular, tumor,
myasthenia gravis,
multiple sclerosis
Distorted vision:
Migraine
Macular degeneration
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Facial Pain
Neuralgias:
Trigeminal (tic douloureux)
Described as 12/10 pain
Usually mandibular and maxillary divisions Patients may be suicidal (psychologically
painful)
Glossopharyngeal
Rare, related to swallowing and movement
of pharynx
Sphenopalatine ganglioneuralgia
Brain-freeze, Ice-cream headache
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Facial Pain
Sinusitis
Dry eye, gritty eye:
Hyperthyroidism (due to
exophthalmos; what is the BP?) Sjgrens Syndrome (autoimmune
attack of exocrine glands that
produce tears and saliva)
Eye pain (w/o vision loss): Retro-orbital = headache, tumor
UTI = Reiters Syndrome
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Facial Pain
History clues:
1) Short, sharp recurrent pain = neuralgias
2) Deep, dull pain worse with bending forward or
atmospheric changes = sinusitis 3) Pain radiating from front of ear and with opening the
mouth = TMJ dysfunction
4) Pain with chewing or hot/cold foods = dental problems
or brain freeze
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Selected Causes of Vision Loss
1) Acute-angle closure glaucoma
Severe pain, halos around light, blurred unilateral
vision, nausea and vomiting (patient may have just
had his/her eyes dilated)
Less than 10% of all glaucoma cases
Senior; will present with eye redness, cloudy-
looking cornea, possibly hyperopic Etiology: blockage of outflow of aqueous humor
from the anterior chamber increasing pressure and
pain (medical emergency)8
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Selected Causes of Vision Loss
2) Open-angle glaucoma
Etiology unknown; patient often describes that the
peripheral field of vision has been cut (usually
the nasal half)
Usually presents bilaterally
Patients often predisposed after past eye surgery or
trauma Evaluation in chiropractic setting is difficult
(elevated intraocular pressure not indicative)
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Selected Causes of Vision Loss
3) Age-related macular degeneration
A) Dry: Slowly developing, painless, central
vision loss
B) Wet (disciform): Sudden, painless loss of
vision (caused by neovascularization)
Leading cause of blindness in geriatric pop.
Fundoscopic findings: drusen, hemorrhages,exudates
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Selected Causes of Vision Loss
4) Retinitis pigmentosa
Affects children and young adults (child reports or
parents notice decreasing night vision)
Hereditary condition (degeneration of the retinal
rods occurs, peripheral ring scotoma)
Dark pigmentation of central retina, yellow waxy
disc observed on fundoscopy Genetic counseling recommended
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