Eye Pain and Neck Discomfort: A Neurological Perspective

Q: Eye Pain and Neck Discomfort: A Neurological Perspective

Hello Mr. <br>Bai： You mentioned that "the assessment indicated a neurological issue, and I was referred to the neurology department, where the neurologist suggested the possibility of migraine?" The symptoms you described may need to consider Trigeminal Autonomic Cephalalgia (TA

Deep pain in the left eye (radiating to the left shoulder and neck)?

Hello, Dr.
Jiang.
Three months ago, I experienced eye pain and visited an ophthalmologist.
The doctor diagnosed my intraocular pressure at the critical value of 21.
I continued to use the prescribed eye drops regularly, and the pain subsided for a while.
During my follow-up visit, the doctor said my condition had returned to normal and provided me with some medication for maintenance or as a backup.
However, since last Thursday morning (a week ago), I have been experiencing deep pain in my left eye (I can't distinguish whether it's a sharp or throbbing pain), which radiates to my left shoulder and neck.
I initially thought my intraocular pressure had risen again, so I reminded myself to use the eye drops on schedule.
Yet, after a few days, the pain persisted.
When I lie on my right side or flat on my back at night, I feel the pain deep within my eye extending downwards, creating a tight sensation in my shoulder and neck (it feels like a rubber band stretched to its limit).
When I lie on my left side, I can only sleep somewhat comfortably if I press the painful area with a blanket or pillow.
Today, I finally decided to visit an ophthalmology clinic during my time off.
This time, I saw another ophthalmologist.
I explained my situation, and he checked my intraocular pressure, which was normal.
However, he mentioned that intraocular pressure levels of 40-50 would cause significant pain and suggested that my issue might be neurological, referring me to a neurologist for further evaluation.
The neurologist mentioned the possibility of migraines and initially prescribed me pain medication and gastric medication, advising me to return for a follow-up next Monday.
I would like to ask what could be causing my pain aside from ocular issues, and is it correct for me to see a neurologist at this point? Thank you, Dr.
Jiang!

Dà Bái, 20~29 year old female. Ask Date: 2022/04/21

Dr. Jiang Junyi reply Neurology

Hello Mr.
Bai: You mentioned that "the assessment indicated a neurological issue, and I was referred to the neurology department, where the neurologist suggested the possibility of migraine?" The symptoms you described may need to consider Trigeminal Autonomic Cephalalgia (TAC), which is a type of headache associated with significant cranial autonomic symptoms.
The primary manifestation involves activation of the trigeminal parasympathetic reflex (such as miosis and nasal congestion), along with secondary clinical signs of cranial sympathetic dysfunction (like forehead and facial sweating).
However, you also mentioned that "when lying on my right side or flat at night, I feel a deep pain in my eye that extends down to my shoulder and neck with tightness," which may also suggest cervical spine-related symptoms.
I recommend undergoing a thorough examination in the neurology clinic to rule out any structural lesions and to discuss headache prevention and management.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital, cares about you.

Reply Date: 2022/04/21

More Info

Hello! Thank you for sharing your detailed medical history and symptoms. Based on your description, it seems that you are experiencing a complex interplay of eye pain, neck discomfort, and possibly neurological issues. Let's break down the potential causes and the appropriate steps you can take moving forward.

Understanding Your Symptoms
1. Eye Pain: You mentioned that your left eye has been experiencing deep pain, which you describe as either throbbing or pressure-like. This pain radiates to your shoulder and neck, suggesting a possible connection between your eye discomfort and cervical (neck) issues.
2. Neck Discomfort: The sensation of tightness or a "rubber band" feeling extending from your eye to your neck could indicate muscle tension or nerve involvement. The neck and head are intricately connected, and issues in one area can often manifest as pain in another.

3. Previous Diagnosis: Your previous eye pressure readings were at the threshold of normal, and you were treated with eye drops, which initially alleviated your symptoms. However, the recurrence of pain suggests that there may be underlying factors that were not fully addressed.

Possible Causes
1. Cervical Issues: Given that your pain radiates to your shoulder and neck, cervical spine problems, such as herniated discs or muscle strain, could be contributing to your symptoms. These conditions can irritate the nerves that supply sensation to the face and eyes, leading to referred pain.

2. Neurological Factors: The neurologist's suggestion of a possible migraine or tension-type headache is worth considering. Migraines can cause unilateral eye pain and are often accompanied by neck discomfort. Tension headaches can also lead to muscle tightness in the neck and shoulders, which may exacerbate your eye pain.

3. Eye-Related Issues: While your eye pressure is currently normal, conditions such as dry eye syndrome, uveitis, or even optic neuritis could cause significant discomfort. These conditions might not always present with elevated eye pressure but can still lead to pain.

Next Steps
1. Follow-Up with Neurology: Since you have already been referred to a neurologist, this is a crucial step. They can perform further evaluations, such as imaging studies (MRI or CT scans) if necessary, to rule out any neurological conditions that might be causing your symptoms.

2. Physical Therapy: If cervical issues are suspected, physical therapy can be beneficial. A physical therapist can help you with exercises to strengthen your neck muscles, improve posture, and relieve tension.

3. Pain Management: The neurologist has prescribed pain medication, which may help manage your symptoms in the short term. It’s essential to monitor how these medications affect your pain levels and report back to your doctor.

4. Lifestyle Adjustments: Consider making adjustments to your daily routine. This includes taking regular breaks from screens, practicing good posture, and incorporating relaxation techniques such as yoga or meditation to reduce overall tension.

5. Regular Monitoring: Keep a symptom diary to track when your pain occurs, its intensity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and treating your condition.

Conclusion
Your current approach of consulting a neurologist is indeed appropriate given your symptoms. It’s essential to explore both the neurological and musculoskeletal aspects of your pain. By addressing both the eye and neck components, you can work towards a comprehensive treatment plan that alleviates your discomfort and improves your quality of life. Remember to communicate openly with your healthcare providers about your symptoms and any changes you experience. Best wishes for your recovery!

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