The Eye and Headache.

PURPOSE OF REVIEW: This article highlights painful conditions involving the eyes that are encountered in practice, emphasizing those that do not have obvious findings on the neurologic examination.

RECENT FINDINGS: Peripheral and central sensitization are associated with chronic neuropathic ocular pain, and hyperalgesia is associated with dry eyes. The aorta and its branches are involved in 25% of patients with giant cell arteritis.

SUMMARY: Eye pain is a common concern and one of the most difficult symptoms for the clinician to evaluate. Eye pain may be a manifestation of a primary headache disorder, as is common in migraine, the trigeminal autonomic cephalalgias, and primary stabbing headache. Secondary headache disorders, such as posterior communicating artery aneurysm, Tolosa-Hunt syndrome, and microvascular ocular motor neuropathies, frequently produce eye pain. Ophthalmic conditions producing eye pain include orbital masses, angle-closure glaucoma, intraocular inflammation, and ocular surface (corneal) disease. Of these, corneal problems are the most commonly encountered.