Deep Eye Pain and Swelling: Possible Causes and Solutions

Deep pain in the orbit and a sensation of eye swelling?

Hello Doctor: I have been experiencing headaches for a year, with a persistent feeling of swelling deep in the area around the right eye socket and nasal bridge.
I feel pressure in my right eye (there is a noticeable difference in size between my eyes), and the area usually feels dull.
When the symptoms are severe, the pressure and pain in the eye socket increase and can radiate to the upper right teeth.
I also experience discomfort in the right side of my neck and the back of my head.
The pain is continuous rather than intermittent.
I have a history of allergic rhinitis, and during allergy episodes, my right eye tends to become red, swollen, and watery, while my right nostril is more prone to runny nose.
A few months ago, I underwent surgery for a deviated septum and inferior turbinate reduction.
An ENT specialist performed a nasal endoscopy, X-rays, and a CT scan, but no issues were identified.
My company's health check-ups over the past two years have also shown no abnormalities (intraocular pressure is normal).
The symptoms are concentrated on the right side of my head; although the pain is not extremely severe, it significantly affects my mood and makes me quite irritable.
This situation has persisted for a year, and my symptoms are quite complex.
I am unsure which department to consult at a large hospital for further examination.
I would appreciate your guidance.
Thank you, Doctor.

Mr. Lan, 20~29 year old female. Ask Date: 2022/12/11

Dr. Jiang Junyi reply Neurology

Dear Mr.
Lan,
You mentioned that "the pressure and pain around the eye area have increased and radiate to the upper right teeth, and there is also discomfort in the right posterior neck and occipital region.
The pain is persistent..." Your symptoms may suggest the possibility of sphenoid sinusitis.
Typically, the nasal congestion symptoms are milder, while the olfactory impairment is more pronounced.
Deep pain in the eyeball can radiate to the top of the head, the occipital area, or behind the ear.
Sphenoid sinusitis is often more challenging to diagnose clinically.
I recommend reducing exposure to allergens in your daily life.
It would be advisable for you to consult with an otolaryngologist and a neurologist for further evaluation and treatment.
Thank you for your inquiry, and feel free to discuss any related questions!
Wishing you good health and peace,
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/12/11

More Info

Understanding deep eye pain and swelling can be quite complex, especially when symptoms persist over an extended period, as in your case. Based on your description, there are several potential causes for the discomfort and swelling you are experiencing in the right eye area, which may include sinus issues, migraines, or even ocular conditions.

Possible Causes
1. Sinusitis: Given your history of allergic rhinitis and the location of your symptoms, sinusitis could be a significant factor. The sinuses are located near the eyes, and inflammation or infection in the sinus cavities can lead to pressure, pain, and swelling around the eyes. Symptoms often include nasal congestion, facial pain, and sometimes fever.

2. Migraines: Migraines can cause unilateral (one-sided) headaches and may be accompanied by visual disturbances, including pressure or pain behind the eye. The fact that your symptoms can radiate to your teeth and neck suggests that they might be related to a migraine or tension-type headache.

3. Ocular Conditions: Conditions such as uveitis (inflammation of the middle layer of the eye) or optic neuritis (inflammation of the optic nerve) can cause deep eye pain and swelling. These conditions may also lead to visual disturbances and require prompt medical evaluation.

4. Nerve-related Issues: The trigeminal nerve, which supplies sensation to the face, could be involved. Conditions affecting this nerve can lead to pain in the eye area and may require further investigation.

5. Allergic Reactions: Your history of allergic rhinitis suggests that allergies could exacerbate your symptoms. Allergic reactions can cause swelling and redness in the eyes, leading to discomfort.

Recommended Actions
Given the complexity of your symptoms and their duration, it is crucial to seek further evaluation. Here are some steps you can take:
1. Consult an Ophthalmologist: Since your symptoms are primarily focused around the eye, an ophthalmologist can conduct a thorough examination to rule out any ocular conditions. They can assess the health of your eyes, check for signs of inflammation, and evaluate your visual function.

2. Follow Up with an ENT Specialist: Since you have a history of nasal surgery and sinus issues, a follow-up with an Ear, Nose, and Throat (ENT) specialist may be beneficial. They can perform additional imaging studies or tests to evaluate your sinuses and determine if there is any underlying issue contributing to your symptoms.

3. Consider Neurological Evaluation: If your symptoms persist or worsen, a consultation with a neurologist may be warranted. They can assess for any neurological conditions that might be causing your symptoms, especially if you experience headaches or other neurological signs.

4. Manage Allergies: Since you have allergic rhinitis, managing your allergies with antihistamines or other allergy medications may help alleviate some of the symptoms. Discuss with your healthcare provider the best options for your situation.

5. Lifestyle Modifications: Consider lifestyle changes that may help reduce your symptoms, such as staying hydrated, managing stress, and ensuring you have a good sleep routine. These factors can significantly impact headache and allergy symptoms.

Conclusion
Your symptoms of deep eye pain and swelling, coupled with a history of allergic rhinitis and recent nasal surgery, warrant a comprehensive evaluation by specialists in ophthalmology and ENT. It is essential to address these symptoms promptly to prevent any potential complications and improve your quality of life. Remember, persistent symptoms should never be ignored, and seeking medical advice is the best course of action.

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