Resolved question:
I am 67 years old patientold and have had no problems with my eyes just until last Saturday -- I am now lying in a hospital bed unable to see straight and in severe pain and the doctors cannot determine the cause.
First I felt pain in my left eye -- first on the far left side of my eye when I looked to my left...this went on for a few days....it steadily got worse. On Tuesday night, I was reading and I looked up and saw double. I went to the hospital emergency room on Weds (of this past week), and they pointed out that my left eye was not moving. Since then, the pain has gotten worse, deeper in my eye and moved over to the right eye which now has limited movement. I also also have pain and nauseas, despite being given medicine to alleviate those symptoms.
The hospital has done many tests, including cat scan, mri, carotid artery, CBC, thyroid, diabetes....they have ruled out everything. They cannot determine what is causing this problem (frozen eyes and pain). They put a patch over my left eye to make it somewhat tolerable to see.
I have no primary care doctor here. There is only the hospitatlist who has brought in a neurologist.
I had my eyes checked a couple of months before in June, there were no problems. I have had no major health concerns.
I am otherwise active and work, but this makes me nonfunctional.
So, the doctors here have exhausted their ideas of what might be causing this. This pain and eye dysfunction seems to be progressing such that I might completely lose my ability to see, and function (because of the sever pain and the significant double vision). This may be a race against time.
What other possible causes should be looked into?
Thank you,
PS: They have given me percoset, adavan, nausea med, blood pressure med, and low dosage of thyroid med. All common causes have been ruled out.
Submitted:
4 Days
Category:
Ophthalmologist
Hello.
Thank you for your query at DoctorSpring.com.
I understand your concern and will do my best to help you.
Summarizing your symptoms, you have pain in the eyes, restricted movements of the eyes and double vision. Also associated nausea.
This could be termed as painful ophthalmoplegia (paralysis of eye muscles).Since all your investigations including imaging studies have come out normal, there can be two very rare possibilities- Orbital Pseudotumor or Tolosa-Hunt Syndrome.
Orbital (eye socket) Pseudotumor is a condition in which there is inflammation and swelling of the eye muscles causing pain, loss of eye movements and double vision. This condition mimics a tumor in the eye but in fact there isn't one. Hence the name "pseudotumor".
Tolosa-Hunt Syndrome is another similar condition with similar symptoms where the location of inflammation differs. Here the cavernous sinus (a venous sinus, something like a thick vein, present within the brain) is inflamed. Since this sinus is surrounded by nerves supplying the eye muscles, it causes symptoms of eye paralysis, pain, double vision etc.
Both these conditions are self-limiting, meaning they resolve on their own but take some time. They also show a very good response to steroids. So for both, the treatment is with steroids.
The diagnosis is by a thorough workup to exclude all other causes of similar complaints. This can be done by doing the following tests.
- Contrast enhanced MRI. If the MRI which was done for you was a contrast enhanced one, there is no need to repeat. The MRI has to be studied for any eye muscle swelling or swelling of the cavernous sinus. These can be present in some cases of Orbital Pseudotumor and Tolosa-Hunt Syndrome respectively. MRI can be completely normal as well in these cases.
- When the MRI is normal or shows changes consistent with cavernous sinus inflammation, further evaluation should include blood and cerebrospinal fluid (CSF) testing to exclude other possible causes of orbital inflammation. Recommended blood testing includes: