After significant head trauma (TBI), patients frequently complain of eye pain. Interestingly, people complain of eye pain even when there was no direct injury to the eyeball itself. An observer would expect that an eye which was directly injured in a motor vehicle accident by contact with glass, an airbag, or a steering wheel would hurt.
In cases of direct eye injury, consultation with an ophthalmologist is obviously crucial. Most of my patients complaining of unilateral or bilateral eye pain do not have eye injuries. Sometimes these patients have injury to the soft tissues and bones around the eye. In these cases, bruising and swelling is often evident, but not in every case. Fractures of bones around the eye can often only be detected by CT or MRI scans of the orbits (the orbit is the space around the eye, the eye socket).
But let’s put those cases aside for a moment. Many patients experience whiplash or blunt force trauma to the head and complain of eye pain. The question is why? And the true answer is doctors don’t always know. Patients with head injuries complain of headaches, and one assumes that makes sense. But in many cases researchers still don’t know the cause of headaches- they can be quite disabling and painful.
Most ophthalmologists are not interested in seeing patients complaining of eye pain unless they have direct eye injuries or other eye disease.
I take a different approach. Do neurologists ignore patients who have headaches with normal CT scans of the brain? Do orthopedic surgeons ignore patients with knee pain that don’t have broken bones or torn ligaments? The answer is obviously no, doctors normally see patients with pain even when scans are normal.
Eye pain is a serious concern. Often these patients believe they are going blind. Even if all I tell a patient with eye pain is that the eye is OK, it’s worth it, they are less fearful. Sometimes the eye pain comes from strain after a head injury and these patients need time away from a computer screen, or perhaps simply glasses. Individuals often become more dependent on reading glasses after trauma and sometimes these patients may benefit from Vision Therapy. This has been discussed in my previous blogs.
Eye pain is real, it’s not just imagined. We have all experienced eye pain after a lengthy reading assignment, it doesn’t even take a head injury. Eye pain, like headaches, can be disabling, and may need to be treated by an ophthalmologist, a neurologist and a chiropractor. The muscles around the eye can become fatigued or go into spasm. Often Advil and Tylenol help, or a neurologist may recommend other tests and medication.
Ophthalmology cannot continue to ignore its role in taking care of traumatic brain injury (TBI) patients with eye pain. This situation is far too common. Other doctors are very concerned they are missing something. I should know, I’ve gotten these calls for 30 years. I specialize in taking care of all patients with TBI- the buck stops here.