Sinusitis or Eye Pressure? Navigating Chronic Pain and Diagnosis

Sinusitis or ocular pressure?

Hello, Doctor.
The patient has been experiencing pressure and dull pain in the upper part of the eyeball and between the eyebrows, along with eye fatigue and a desire to rest.
They have undergone MRI of the brain by a neurologist multiple times, but no significant findings were noted.
Due to recurrent episodes of incomplete sinusitis, they were diagnosed with chronic sinusitis.
Although the symptoms align with sinusitis and the CT scan appears not severe, they underwent two FSSE surgeries.
The first surgery did not address the frontal sinus adequately as the doctor deemed it not serious; post-operation, the yellow nasal discharge decreased somewhat, but the pressure and pain in the upper eye and between the eyebrows persisted.
Consequently, a partial frontal sinus procedure was performed.
However, about a month post-surgery, the symptoms have not improved.

Regarding this issue:
1.
The doctors have ruled out OSA and other internal medicine problems, and there are no issues from the ophthalmology perspective.

2.
Should we take the original MRI to a neurosurgeon for a re-evaluation? (Previously, I consulted with a neurologist and ENT specialist.)
3.
The pain (which worsens during sleep) is a dull ache that lasts all day, rather than sharp or severe pain, and it does not go away, which is why trigeminal neuralgia has been ruled out.
When experiencing the pressure and pain, the patient feels the need to close their eyes and rest, feeling very fatigued and having visual disturbances, yet they do not lack physical strength.
I am uncertain about the next steps to take...

JS, 40~49 year old female. Ask Date: 2018/12/02

Dr. Zhang Junwei reply Neurosurgery

If you have already consulted with neurology and ENT specialists without finding any issues, it is advisable to consider a consultation with a neurosurgery clinic.

Reply Date: 2018/12/02

More Info

Chronic pain in the eye area, particularly when associated with sinusitis, can be quite complex to diagnose and manage. Your symptoms of pressure and pain in the upper eye and forehead, along with fatigue and difficulty focusing, suggest a potential overlap between sinus-related issues and other ocular or neurological conditions. Given your history of chronic sinusitis and previous evaluations, let's explore your concerns in detail.

1. Understanding Your Symptoms: The symptoms you describe—pressure in the upper eye, forehead pain, and fatigue—are indeed common in cases of chronic sinusitis. The sinuses are located close to the eyes, and inflammation or infection in the sinus cavities can lead to referred pain in the eye area. This can manifest as a feeling of pressure or discomfort, which may be exacerbated by activities that increase intracranial pressure, such as bending over or straining during bowel movements.

2. Previous Evaluations: It’s important to note that you have undergone MRI scans and evaluations by both neurologists and ENT specialists, which have not revealed significant findings. This is a positive aspect, as it suggests that serious conditions such as tumors or significant structural abnormalities have been ruled out. However, the persistence of your symptoms indicates that further investigation may be warranted.

3. Next Steps in Diagnosis: Given that your symptoms have not improved after two surgeries for sinus issues, it may be beneficial to consult a neurosurgeon for a second opinion. They can review your MRI and assess whether there are any subtle issues that may have been overlooked, such as anatomical variations or other conditions that could be contributing to your pain. Additionally, they may consider whether there is any involvement of the trigeminal nerve, which can cause facial pain, though you mentioned that this has been ruled out.

4. Management of Symptoms: In the meantime, managing your symptoms is crucial. Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), may help alleviate some of the discomfort. Additionally, using saline nasal sprays or a humidifier can help keep your nasal passages moist and may reduce sinus pressure. If you have not already, consider consulting with a pain management specialist who can provide strategies for managing chronic pain, including physical therapy or alternative therapies such as acupuncture.

5. Psychological Impact: Chronic pain can take a toll on mental health, leading to feelings of frustration and anxiety. It’s essential to address these aspects as well. Cognitive-behavioral therapy (CBT) can be beneficial in helping you cope with chronic pain and its psychological effects. Mindfulness and relaxation techniques may also help reduce the perception of pain and improve your overall well-being.

6. Monitoring and Follow-Up: Continue to monitor your symptoms and maintain regular follow-ups with your healthcare providers. Keeping a symptom diary can be helpful in identifying triggers or patterns that may assist in diagnosis and treatment. If new symptoms arise or if your current symptoms worsen, seek medical attention promptly.

In conclusion, navigating chronic pain associated with sinusitis and potential eye pressure requires a multidisciplinary approach. Collaborating with various specialists, including ENT, neurology, and pain management, can provide a comprehensive strategy to address your symptoms effectively. Remember, you are not alone in this journey, and there are resources and support available to help you manage your condition.

Similar Q&A

Understanding Eye Pressure and Discomfort: Causes and Solutions

Hello, doctor. For the past six months, I have been experiencing a feeling of pressure and mild pain in my upper eye, along with slightly blurred vision and difficulty focusing, although I have not experienced double vision. Additionally, I have been having a dull headache that r...

Dr. Gao Pilin reply Ophthalmology
Hello: Sinusitis can indeed cause a sensation of pressure or discomfort. It's important to fully treat the sinusitis and see if the symptoms improve. If the issue is related to the eyes, it usually alleviates with rest. If you are using your eyes all day, you will need to ta...

Understanding Facial Pain: From Sinusitis to Neurological Issues

Hello Doctor, I previously visited an ENT specialist due to facial pain, and the doctor diagnosed me with acute sinusitis causing the facial pain. However, he found it strange that I was experiencing pain on the right side of my face while having left-sided sinusitis. After thr...

Dr. Zeng Kongyan reply Neurology
The pain you are experiencing is located in the right cheek and is characterized as paroxysmal, having persisted for nearly a month. After evaluations by both the otolaryngology and neurology departments, no significant improvement has been achieved. Given these circumstances, it...

Which Specialist to Consult for Headaches and Eye Pain?

Headache and pain in the forehead, red and painful eyes, runny nose, excessive nasal discharge when blowing the nose, and a persistent cough. No smoking or alcohol consumption.

Dr. Cai Jueren reply Family Medicine
Hello, the symptoms you described are likely related to migraines and may also be caused by chronic sinusitis. I recommend that you visit an otolaryngologist for an examination, which should help resolve your concerns. Thank you for your inquiry, and I hope the above information ...

Understanding Sinus Cysts: Symptoms, Diagnosis, and Next Steps

Hello Doctor: I have been experiencing discomfort in my nose for about two years, primarily with persistent nasal congestion on the left side. Additionally, I feel a pressure sensation behind my left eye, as if something is pushing against it, which has been occurring for about t...

Dr. Hu Kexin reply Otolaryngology
Hello: In response to your question, currently, CT or MRI scans are considered more detailed examinations for sinus lesions, including conditions such as sinus cysts or sinusitis, which can be detected. If there are nasal polyps, they are likely associated with chronic sinusitis ...