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Medical Forum / General / Vision / May 2007Eye/orbit pain for a few months, please help
Hi, when I frown or move the right eyebrow or touch/press it, I feel dull pain in the area and deep inside the head, it's like this for a few months now, usually feel less in the morning, but getting worse late at night. I use computer alot but I don't think it's eyestrain since my left eye is fine even though it has higher degree of nearsightness. I tried different type of eyeglasses, not sure if this is caused by eyeglass nose piece pressing on the sinus area, although putting some soft tissue cushion seems to help. I went to see a opathomologist who did a complete eye exam on me, but he found nothing wrong in the right eye (except central serous retinopathy which is not realated to pain), he said could be neuralgia, although he said may not be necessary but he still gave me a prescription of MRI scan in the orbit area, but I want to get some idea before I spend the money going that route. Do you have any suggestion what is causing this pain? it's not sharp pain but it's always there whenever I move my eyebrow or eye or even sleep on the right side, it's quite depressing, I never had any injury or infection that I can think of... If I have to do the MRI, should I only do the orbit or include the brain (since it maybe related to head as the pain goes into the head)? one imaging lab charge double if include the head but the other said it's the same charge just do the whole head scan. I am a bit lost here. thanks a lot! On Apr 16, 10:13 pm, ns66...@yahoo.com wrote: > Hi, when I frown or move the right eyebrow or touch/press it, I feel > dull pain in the area and deep inside the head, it's like this for a [quoted text clipped - 26 lines] > > thanks a lot! I am a chiropractor and personally prefer natural remedies, but first you always want to rule out any underlying problems. It's great that you got checked by the eye doctor and your body passed in that department, but I would now get checked by a neurologist. He probably would want to see and MRI of both brain and orbit. If everything checks out fine, and all major problems are ruled out, I would try acupuncure, which has been known to work great with nueralgia. By today's medical explanations it's hard to describe how, but acupuncture has been around for thousands of years and has helped people without the use of drugs or surgery. I assume you don't have health insurance? I know it's really difficult these days to squeeze out an extra few hundred dollars a month, but if there's any way you can re-budget, it will be well worth it in times like these. Good luck! Falala thanks for the reply, the doctor back from vacation left a message today saying my pain could also be migraine and a word sounds like "arosure" (what is that?). I think if I want to check further I would do MRI with brain/orbit first, if there's anything wrong there I would go see a neurologist as you suggested? is the whole head MRI scan less detailed than orbit only? that's my concern since one lab said cost the same, which makes me wonder... thanks > is the whole head MRI scan less detailed than orbit only? that's my > concern since one lab said cost the same, which makes me wonder... Like they scale down the resolution to capture the whole head? Nope. It's more likely they charge full price for partial procedures. Sinus pain can present like yours. What happens if you take a couple of sudafed? -MT > <ns66...@yahoo.com> wrote > [quoted text clipped - 8 lines] > > -MT thanks for the reply. I never took that, and no idea what it does... i have never felt this pain, just happened a few months ago, that's why I am a bit worried if there's something wrong there like tumor or something like that? I don't have congested nose or running nose or something like that, although after I blow nose sometimes I see traces of blood on tissue but most of the time not. On Apr 17, 10:08 pm, ns66...@yahoo.com wrote: > > <ns66...@yahoo.com> wrote > [quoted text clipped - 16 lines] > although after I blow nose sometimes I see traces of blood on tissue > but most of the time not. dr. tyner is describing a scenario that is common in patients who complain of deep pain/pressure in the areas around the eye, at least in my practice. either chronic or acute sinusitis is a distinct possibility. to test this hypothesis I would recommend a 10 day round of antibiotics (cephalexin and zithromax are good candidates and both are available as generics) as well as taking of 30-60 mg pseudoephedrine q6 hours. blocked and infected sinuses give rise to lots of non-specific complaints that include what you are describing. chronic sinusitis would not be accompanied by nasal congestion and could certainly give rise to streaking of blood when you you blow your nose. its simple enough to test that treatment approach! ps-- also, long exposure to humid warm air might help to open up blocked sinuses. for example, a long hot shower or a steam bath. good luck. thank you and dr. tyner for the replies. I think it might be chronic sinusitis turn worse since I have this streaks of blood when blow nose since years ago just no other symptoms so I never paid attension. I will try this treatment to see if it improves and report back. and postpone the MRI (can MRI dectect the sinusitis?) what's q6 hours? every 6 hours? I will try antibiotics for 10 days, how long should I take sudafed and how many times a day? thank you and appreciate your help > what's q6 hours? every 6 hours? Yes. > I will try antibiotics for 10 days, In the US we can't do this without a prescription. > how long should I take sudafed and how many times a day? I'd suggest 2 tablets twice a day, no more. The 12-hour long-acting is more likely to cause side effects. It should make you thirsty and you should avoid pseudoephedrine if you have uncontrolled high blood pressure. An MRI should detect sinusitis but plain ol' skull xrays can, also. -MT > thanks for the reply. > I never took that, and no idea what it does... Sudafed is a brand of pseudoephedrine, a powerful decongestant available in the US without prescription. > i have never felt this > pain, just happened a few months ago, that's why I am a bit worried if > there's something wrong there like tumor or something like that? We have a saying... when you hear hoofbeats, first think horses, then zebras. > I > don't have congested nose or running nose or something like that, > although after I blow nose sometimes I see traces of blood on tissue > but most of the time not. If a sinus is swollen shut, it might not produce much of a discharge. Sinus pain often increases when you bend over or stand up. -MT > <ns66...@yahoo.com> wrote > [quoted text clipped - 21 lines] > > -MT thanks for the reply. I don't particularly notice increased pain when bend over or stand up, only if I move right eyebrow, also I don't have congested nose and no problem at all breathing... Hi, I tried cephalexin for 10 days and sudafed for 6 days, it didn't seem to cure it, I still feel the pain. so I went to a MRI imaging center and did MRI 1.5T for orbits and brain. here is the report: The ventricles and sulci are within normal limits. The flair imaging demonstrates a small hyperintensity lesion in the right frontal subcortical white matter. the brain parenchyma is otherwise normal in signal intensity and configuration. No acute hemorrhage, mass lesion or mass effect is demonstrated intracranially. the patient has septum pellucidum, normal variant. there is no extraaxial collection. the sella is normal in size. the craniovertebral junction is normal. the internal carotid arteries and basilar artery show normal flow void signal intensity. the globes are normal in size and configuration. the optic nerves are normal in size, course and signal intensity. the extraocular muscles and retrobulbar fat are unremarkable bilaterally. the optic chiasm is intact. there is mild mucosal thickening of the bilateral ethmoid, frontal and maxillary sinuses compatible with chronic sinusitis. the right maxillary sinus demonstrates a polyp versus retention cyst measuring 1.8x.1.8 cm in the inferior all. there's no evidence of air-fluid level. the osteomeatal complex is patent bilaterally. the nasal septum is midline. the nasal cavity is unremarkable. IMPRESSION: 1. single small right frontal white matter lesion is nonspecific and may represent small vessel ischemic disease or gliosis. 2. normal variant septum pellucidum 3. chronic paranasal sinusitis. 4. polyp versus retention cyst in the right maxillary sinus. I don't understand much about this report, seems like there's a sizable tumor that need be removed? is that the reason I feel the pain? if it's I am happy at least I know what's the cause. what kind of doctor do I need to see? a surgeon? thank you very much. > I don't understand much about this report, seems like there's a > sizable tumor that need be removed? is that the reason I feel the > pain? if it's I am happy at least I know what's the cause. > what kind of doctor do I need to see? a surgeon? Polyps and fluid retention cysts don't usually hurt. Sinusitis usually hurts. Yours is pretty generalized, not localized to the right cheekbone. I'd recommend you return to the ophthalmologist who ordered the MRI, hoping he'd treat the inflammation before trying to cut anything out. -MT dr. tyner, thanks for the reply, I just noticed the cysts as you said is located on the right cheerbone, which is not where it hurts, the pain is on the right eyebrows area closer to the nose and goes inside head, and as you said if cysts usually doesn't hurt, is it relatively safe to assume that it's not the cause of the pain? chronic paranasal sinusitis is most likely the cause of the pain? can it be cured? I took 10 days of cephalexin and went back to my old pair of glass (with nose pieces lower than the new pair and worn for 10 years without pain), the pain is less but still there... I already mailed the report to my eye doctor. thanks > dr. tyner, thanks for the reply, I just noticed the cysts as you said > is located on the right cheerbone, It's inside the right maxillary sinus and "polyp vs retention cyst" means the MRI can't distinguish between these two fairly benign conditions. > head, and as you said if cysts usually doesn't hurt, is it relatively > safe to assume that it's not the cause of the pain? It isn't safe for you or me to assume anything. I'd get some advice about the polyp/cyst - I have no experience with those, except they aren't likely inflammatory and not likely the cause of your (more generalized) pain. I suggested returning to the ophthalmologist because I gather you're paying out-of-pocket and this doctor already knows you so you'll get further information and advice without paying for an entire new workup. If he recommends an ENT doc, then you know that's the best route to take. I'd be surprised if he gets alarmed about the polyp/cyst. -MT dr. tyner, thanks for the reply. I got a message from eye doctor recommending an ENT doctor, I haven't decided to go to see him yet (very little information available about him). I searched for some ENT doctors, I don't see any specialized in chronic sinusitis, but found a few in Sinus Disorders/Surgery, is that the specialty best suit my situation? On May 5, 7:51 pm, ns66...@yahoo.com wrote: > Hi, I tried cephalexin for 10 days and sudafed for 6 days, it didn't > seem to cure it, I still feel the pain. so I went to a MRI imaging [quoted text clipped - 33 lines] > pain? if it's I am happy at least I know what's the cause. > what kind of doctor do I need to see? a surgeon? It seems like sinusitis, so the answer is almost obvious: ENT. thanks for the reply On May 5, 10:51 pm, ns66...@yahoo.com wrote: > Hi, I tried cephalexin for 10 days and sudafed for 6 days, it didn't > seem to cure it, I still feel the pain. so I went to a MRI imaging [quoted text clipped - 35 lines] > > thank you very much. The doctor who ordered the MRI should be following up and advising you on the next steps. Likely will involve an ear, nose and throat doctor as the sinuses are involved. Whether or not a tumour needs to be removed depends on what the term "single white lesion" means and you and most of us are not in a position to know that. Dr Judy dr judy thanks for the reply, will ENT doctor know what that "single white lesion" means? I have 3 print out images, I don't know if ENT doctor can locate the thing from pictures or need cooperation from imagining center? I don't see "exact location" on the report. do I need to see a neurologist? thanks ns666ns@yahoo.com wrote in news:1178562833.562958.154490 @p77g2000hsh.googlegroups.com: > dr judy thanks for the reply, will ENT doctor know what that "single > white lesion" means? I have 3 print out images, I don't know if ENT [quoted text clipped - 3 lines] > > thanks The ENT probably won't deal with the white *matter* lesion, but try to make sure your primary care physician gets a copy of the report. It really sounds like your problem is sinuses, though. Give the ENT his crack at it. You've had three or four practitioners tell you that your problems sound sinus-related, and an MRI confirming chronic sinusitis. The "tumor" that is more likely related to your pain is sinus-related, and likely has nothing to do with the white matter lesion. Do some googling for gliosis, and make sure your primary doctor knows about it. My suspicion is that they may want follow up imaging at some time in the future, but that nothing will really be done unless you show neurological symptoms-- or maybe if the sinus stuff is cleared up and your pain remains.  SignatureScott (not a doctor) Reverse name to reply > dr judy thanks for the reply, will ENT doctor know what that "single > white lesion" means? I have 3 print out images, I don't know if ENT > doctor can locate the thing from pictures or need cooperation from > imagining center? I don't see "exact location" on the report. do I > need to see a neurologist? I didn't see "single white lesion" in the report. If you're talking about the "small hyperintensity lesion" it's probably ancient history and it's located such that you wouldn't do any sort of surgery without knowing it represents a major problem. Which isn't likely, from the report. -MT |
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