Which Specialist Should You Consult for Eye and Jaw Pain?

Which specialty should I see?

Hello, my mother has been experiencing intermittent swelling and pain in her lower eyelids since last year.
Before these eyelid issues occur, she often feels pain near the lower jaw area, just below the ears, accompanied by headaches.
Taking anti-inflammatory medication helps alleviate the pain, but the swelling of the lower eyelids, difficulty in opening her eyes, excessive tearing, and pain take a longer time to improve.
She has consulted ophthalmology, nephrology, neurology, and otolaryngology, but none have provided relief.
The frequency of these episodes has increased this year, significantly impacting her daily life.
Which specialty should she consult for better management? Thank you for your time.

Note: The results from various specialties are as follows:
- Ophthalmology: Mild cataracts and dry eye syndrome; currently using eye drops.
- Nephrology: No relation to eyelid swelling.
- Neurology: No abnormalities found.
- Otolaryngology: Nasolacrimal duct has been cleared.
My mother is 65 years old and has a history of heart disease, hypertension, and diabetes.

Symptoms before onset: Pain near the lower jaw area, just below the ears, followed by headaches about a day later.
Symptoms during episodes: Swelling of both lower eyelids, difficulty in opening her eyes, excessive tearing, and pain (resting with closed eyes reduces discomfort), and she cannot keep her eyes open for extended periods.

connie, 30~39 year old female. Ask Date: 2008/08/20

Dr. Cai Mengru reply Family Medicine

Dear Ms.
Connie,
Regarding your daughter's symptoms, it seems challenging to attribute them to a single disease.
There are several noteworthy possibilities:
1.
Headache: Common chronic headaches include migraines and tension-type headaches.
The former tends to significantly impact daily life, often accompanied by light sensitivity, nausea, and vomiting, and is usually more intense.
The latter is characterized by a prolonged dull pain in the head.
Additionally, issues related to the temporomandibular joint (TMJ) can also trigger headaches, which could be a possibility in your daughter's case.
2.
Eyelid swelling: If there is no accompanying edema in the lower extremities or other areas, it may stem from a localized issue, such as local inflammation or allergies causing circulation problems in that area.
In summary, there are many potential explanations.
Given your daughter's situation, it would be advisable to first visit a family medicine physician to rule out common issues and manage symptoms (such as poorly controlled diabetes or psychosomatic problems).
Notably, TMJ issues are typically addressed by a dentist, and this specialization is more commonly found in regional hospitals and above.
I hope this response is helpful.
Sincerely,
Dr.
Tsai Meng-Ju
Department of Family Medicine, Taoyuan Hospital

Reply Date: 2008/08/20

More Info

Based on the symptoms you've described regarding your mother's condition, it seems that she is experiencing a complex interplay of eye and jaw pain, along with swelling and discomfort in the lower eyelids. Given her medical history and the various specialists she has already consulted, it is crucial to approach this situation with a comprehensive understanding.

Firstly, the symptoms of swelling in the lower eyelids, difficulty in opening the eyes, and associated pain in the jaw area could suggest several underlying issues. The fact that these symptoms are preceded by pain in the jaw area, particularly near the lower jaw and ears, raises the possibility of a connection to the temporomandibular joint (TMJ). TMJ disorders can cause referred pain that manifests in the jaw, ears, and even the eyes, leading to discomfort and swelling.

Since your mother has already seen specialists in ophthalmology, nephrology, neurology, and otolaryngology (ENT) without significant improvement, it may be beneficial to consult a specialist in oral and maxillofacial surgery or a dentist with expertise in TMJ disorders. These specialists can evaluate the jaw's alignment and function, assess for any signs of bruxism (teeth grinding), and determine if there are any issues with the temporomandibular joint that could be contributing to her symptoms.

Additionally, considering her age and existing health conditions, such as heart disease, hypertension, and diabetes, it is essential to ensure that any treatment plan is tailored to her overall health status. Chronic conditions can complicate treatment options and may require a multidisciplinary approach.

In terms of managing her symptoms, it may be helpful to explore conservative treatments for TMJ disorders, which can include:
1. Physical Therapy: A physical therapist specializing in TMJ disorders can provide exercises to strengthen the jaw muscles and improve mobility.

2. Heat and Cold Therapy: Applying warm compresses to the jaw can help relax the muscles, while cold packs can reduce inflammation.

3. Medications: Over-the-counter anti-inflammatory medications may help alleviate pain and swelling. However, it's crucial to consult her primary care physician before starting any new medication, especially considering her existing health conditions.

4. Stress Management: Since stress can exacerbate TMJ symptoms, techniques such as mindfulness, meditation, or yoga may be beneficial.

5. Dental Evaluation: A dentist can assess for any dental issues that may contribute to jaw pain, such as misaligned teeth or bite problems.

6. Dietary Changes: Soft foods may reduce strain on the jaw, especially during flare-ups.

If these conservative measures do not provide relief, further evaluation may be necessary, including imaging studies like MRI or CT scans to assess the TMJ and surrounding structures.

In summary, given your mother's complex symptoms and the lack of resolution from previous consultations, I recommend seeking an evaluation from a specialist in oral and maxillofacial surgery or a dentist with expertise in TMJ disorders. This approach may provide insights into the jaw-related issues that could be contributing to her eye pain and swelling. Additionally, a multidisciplinary approach involving her primary care physician, ophthalmologist, and any other relevant specialists will ensure that her treatment plan is comprehensive and considers all aspects of her health.

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