1. Raed Behbehani , MD FRCSC

2. •Periocular pain due to diseases of the face, orbit, sinuses , and
intracranial cavity.
•Trigeminal innervation (V1-V3).
•Primary headache syndrome vs Secondary headache syndrome

3. • Any headache can cause eye pain (vice versa).
• Take good history ( loss of vision, diplopia, redness, photophobia,
jaw claudication, systemic symptoms).
• Examination : check vision at least grossly, look for redness, ptosis,
corneal edema, check pupil reactions, palpate the eyes and orbits,
check sensation v1-v3 and other cranial nerves.
•FUNDOSCOPY !

4. • Migraine (with / without aura)
•Cluster Headache .
•Tension Headache.
•Chronic Daily Headache.
•Medication overuse.

5. • Ocular disease.
• Orbital disease.
• Vascular disease.
• Intracranial disease .

7. • Inadequate tear production.
• Primary / Secondary to rheumatological conditions.
• Slit lamp examination : Flourescin stain/ Rose bengal
• Artificial tears/ punctal occlusion is the treatment.

9. • Anterior/Posterior Uveitis.
•Pain and Photophobia.
• Cells in the anterior chamber/ Ciliary injection/ Posterior
synechiae.
• Idiopathic/ associated with rheumatologic conditions/ infectious
(post-operative).
• Topical steroids for anterior / periocular and systemic for posterior
• Intravitreal antibiotics for infectious post-operative.

11. • Severe periocular pain +- headache.
• Blurred vision , nausea , and vomiting.
• Cilliary injection/ corneal edema/ fixed mid-dilated pupil.
• Previous history of transient visual disturbances .
• Laser iridotomy.

13. • New onset of headache (temporal) , acute or transient loss of vision,
jaw claudication, weight loss, fever, and myalgias.
• Age over 60.
• Anterior/posterior ischemic optic neuropathy
• Retinal artery occlusion.
• ESR, CRP, CBC.
• Systemic steroids ( oral or IV).
• Temporal artery biopsy.

14. .
• Deep boring pain in the eye upon standing up or with sustained
exposure to light (ocular claudication) .
•Impaired retinal cicrulation due stenosis of the aoortic
arch/carotids.
• Fundus examination shows sign of ischemia (dilated retinal veins,
hemorrhages, cotton wool spots, neovascularization).
• ? Carotid endarterectomy.

16. • Incorrect glasses/ contact lenses.
• Uncorrected presbyopia.

17. • Optic neuritis.
• Orbital inflammtory disease.
• Orbital mass.
• Orbital vascular malformation.

18. • Sudden onset.
•Pain, proptosis, limited eye movement, chemosis.
• Idiopathic or due to Wegener’s granulmatosis, Grave s’ disease,
sarcoidosis)

21. • Can be primary (pseudo-tumor cerebri) or secondary (mass,
hemorrhage)
• Headache, pain in the neck and shoulders and upper back.
•Worse with coughing/straining.
•Pulsatile tinnitis.
•Transient visual obscurations.
• Diplopia.
• Treatment of pseudotumor cerebri is Medical ( Diamox ) or Surgical
(Optic nerve sheath fenstration, V-P or V-A shunt).

23. • Take good history ( try to distinguish primary from secondary
headache syndrome).
• Look for abnormal neuro-ophthalmic signs ( Ptosis,
ophthalmoplegia, abnormal facial sensation, check visual acuity,
and pupils, and look for papilledema).
• Giant cell arteritis is vision-threatening.
• Papilledema ican be life threatening.