Periocular Pain
Pain in, around, or behind eye May originate in eye, orbit, sinuses, or intracranial space Many supratentorial intracranial processes affect trigeminal branches causing pain referred to eye Chief ocular concerns are: acute angle-closure glaucoma, endophthalmitis, giant cell arteritis
May have no distinguishing features, but worth probing for them in past medical history, ophthalmic findings, and headache duration, frequency, nature, intensity, triggers, relievers, and accompanying symptoms
Pain is pain—patients have trouble describing it and physicians have trouble diagnosing its cause
Try to make a presumptive diagnosis Refer to ophthalmologist with urgency dependent on duration of symptoms Head imaging often necessary
Depends on underlying cause Vision-threatening and life-threatening conditions may be announced by pain
