Eye-related headache

Differential diagnosis
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By Michael Marmura MD

Eyelid disorders

  • Vision: normal
  • Proptosis: absent
  • Ptosis: edema may mimic
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: present
  • Intraocular pressure: normal

Dacryoadenitis

  • Vision: normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: present
  • Intraocular pressure: normal
  • Other: localized swelling, pain, and tenderness

Periorbital cellulitis

  • Vision: may have irritated eye movement
  • Proptosis: absent
  • Ptosis: edema may mimic
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: present
  • Intraocular pressure: may be elevated
  • Other: untreated can cause septic cavernous thrombosis

Conjunctivitis

  • Vision: normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: mild
  • Local signs of inflammation: present
  • Intraocular pressure: normal

Hyphema

  • Vision: abrupt decrease in vision
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: present
  • Intraocular pressure: can be elevated

Anterior uveitis - iritis

  • Vision: decreased
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: miosis, irregular
  • Photophobia: present
  • Local signs of inflammation: present
  • Intraocular pressure: normal
  • Other: mydriatics relieve symptoms

Anterior uveitis - iridocyclitis

  • Vision: decreased
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: miosis
  • Photophobia: consensual photophobia
  • Local signs of inflammation: present
  • Intraocular pressure: normal

Posterior uveitis

  • Vision: decreased
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: absent
  • Photophobia: absent
  • Local signs of inflammation: absent
  • Intraocular pressure: normal

Corneal disorders

  • Vision: decreased
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: absent
  • Photophobia: present
  • Local signs of inflammation: present
  • Intraocular pressure: normal

Acute angle-closure glaucoma

  • Vision: decreased
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: fixed mid-dilated, oval
  • Photophobia: present
  • Local signs of inflammation: present
  • Intraocular pressure: high
  • Other: mydriatic = disaster

Subacute angle-closure glaucoma

  • Vision: absent or mild blurring
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: enlarged
  • Photophobia: present during episode
  • Local signs of inflammation: usually absent
  • Intraocular pressure: usually normal
  • Other: elevated cup-to-disc ratio

Chronic angle-closure glaucoma

  • Vision: usually normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: absent
  • Intraocular pressure: usually normal
  • Other: elevated disc-to-cup ratio

Scleritis

  • Vision: normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: present
  • Local signs of inflammation: usually present, globe tender
  • Intraocular pressure: normal
  • Other: posterior scleritis may cause eye pain with "white" eye

Episcleritis

  • Vision: normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: present
  • Local signs of inflammation: present
  • Intraocular pressure: normal
  • Other: minimal pain; often idiopathic, whereas scleritis is often associated with immune-related diseases

Endophthalmitis

  • Vision: blurred
  • Proptosis: normal
  • Ptosis: normal
  • Pupils: normal
  • Photophobia: present
  • Local signs of inflammation: present
  • Intraocular pressure: normal

Orbital disease

  • Vision: may be decreased; diplopia
  • Proptosis: present
  • Ptosis: may be present
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: present
  • Intraocular pressure: may be elevated
  • Other: systemic symptoms and fever common

Cavernous sinus thrombosis

  • Vision: may be decreased; diplopia
  • Proptosis: present
  • Ptosis: may be present
  • Pupils: oculomotor or Horner syndrome may be present
  • Photophobia: minimal
  • Local signs of inflammation: present
  • Intraocular pressure: may be elevated

Dysthyroid ophthalmopathy

  • Vision: usually normal; diplopia
  • Proptosis: present; may be unilateral or bilateral
  • Ptosis: uncommon
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: may be present
  • Intraocular pressure: may be elevated
  • Other: thyroid studies may be normal

Parasellar syndrome

  • Vision: diplopia due to third, fourth, or sixth nerve palsy
  • Proptosis: absent
  • Ptosis: may be present
  • Pupils: third nerve mydriasis
  • Photophobia: absent
  • Local signs of inflammation: absent
  • Intraocular pressure: normal

Pituitary apoplexy

  • Vision: blurred vision and diplopia often present
  • Proptosis: absent
  • Ptosis: may be present
  • Pupils: third nerve mydriasis
  • Photophobia: absent
  • Local signs of inflammation: absent
  • Intraocular pressure: normal
  • Other: cerebral symptoms and cranial neuropathy common

Optic neuritis

  • Vision: present, but eye pain may precede visual loss in 40% of patients
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: relative afferent pupillary defect
  • Photophobia: present
  • Local signs of inflammation: absent
  • Intraocular pressure: normal

Referred pain (eg, sinusitis)

  • Vision: normal
  • Proptosis: absent
  • Ptosis: absent
  • Pupils: normal
  • Photophobia: absent
  • Local signs of inflammation: pericranial inflammation
  • Intraocular pressure: normal
  • Other: purulent discharge; postural exacerbation

In This Article

Introduction
Overview
Differential diagnosis
References cited
Contributors