Photophobia accompanies some primary, secondary cephalgia, meningitis, encephalitis, cerebral circulatory disorders, general infections, injuries, inflammatory and non-inflammatory eye diseases. In case of neurological pathologies, it can be combined with general cerebral and focal symptoms, with infections - with intoxication syndrome, with eye diseases - with lacrimation, blurred vision. To determine the cause of photophobia, data from a survey, neurological and ophthalmological examination, and additional studies are used. Treatment - antimicrobial and antihistamines, immunomodulators, surgical interventions.
Why does photophobia occur?
Physiological causes
Normally, short-term photophobia is noted in all people who fall from darkness into a brightly lit space. Disappears after eye adaptation to lighting conditions. It is found among actors, lecturers, representatives of other professions, who are forced to be “in the light of spotlights” for a long time. Develops after prolonged exposure to the sun without goggles.
cephalgia
Photophobia is observed in the following primary and secondary cephalgia:
- Migraine. Photophobia is one of the constant signs of the disease, combined with intolerance to sounds, pallor, and weakness. Headaches are intense, throbbing, pressing, paroxysmal. Spread over half of the head. The affected side may change from time to time. Sometimes the attack is preceded by a prodrome or autonomic aura.
- Tension headache. The duration of paroxysm ranges from several minutes to several days. Cephalgia slight or moderate, pressing, bilateral, reminiscent of the feeling of "squeezing a hoop." Photophobia is not a permanent manifestation of the disease, it is found in some patients, supplemented by phonophobia.
- Abuse headache. This secondary cephalgia develops in patients with headaches of various origins with constant use of analgesics. Compressive, squeezing, diffuse, symmetrical, more pronounced in the morning. With migraine, it is supplemented by migraine-like attacks with the development of photophobia, nausea and vomiting.
Inflammatory processes in the CNS
Meningitis manifests with general weakness, weakness, which are quickly replaced by severe hyperthermia, chills, fever, tachycardia, tachypnea, and vomiting. A characteristic symptom of the pathology is meningeal syndrome - tonic muscle tension. Headaches are excruciating, bursting. Severe photophobia, painful perception of touch and any noise are noted.
The symptom can also be detected with tick-borne, influenza, measles encephalitis. Along with photophobia, fever, cerebral symptoms, and disorders of consciousness are noted. The clinical picture varies to some extent depending on the form of the disease. With brain abscesses, manifestations are variable, cerebral, meningeal and focal symptoms are possible. Photophobia does not always occur.
Cerebral circulation disorders
In stroke, as in abscesses, there is a combination of meningeal, cerebral and focal symptoms. Pathology develops suddenly, progresses rapidly. Headaches, nausea, vomiting, impaired consciousness, various types of hemiparesis, and sometimes photophobia are found. Transient NMC are accompanied by similar manifestations, but the condition does not reach the same severity as with a stroke, all changes disappear within a day.
Photophobia
infectious diseases
Photophobia is often observed in common infections, is part of the intoxication syndrome. It is combined with chills, hyperthermia, weakness, arthralgia, myalgia. In most cases, signs of inflammation of the upper respiratory tract are detected. Viral infections that provoke photophobia include SARS, influenza, measles. With the bacterial nature of the disease, the symptom is determined in patients with tonsillitis and diphtheria.
Rabies is a dangerous infectious disease with severe photophobia. Initially, depression occurs, in some cases with general malaise and fever to subfebrile numbers. After 2-3 days, various phobias appear: photophobia, fear of water, noise, air movement. There are short-term attacks of convulsions and spasms, aggression, arousal. Paroxysms become more frequent, and then are replaced by paralysis, cessation of breathing and cardiac activity.
Inflammatory eye diseases
Along with lacrimation and various unpleasant sensations, photophobia is a typical symptom of many ophthalmic pathologies:
- Conjunctivitis. The patient complains of burning, itching, feeling of "sand" in the eyes. Photophobia is complemented by blepharospasm, purulent or mucous discharge, swelling and redness of the eyelids. After awakening, the patient cannot open his eyes due to the gluing of the eyelids with a dried secret.
- Keratoconjunctivitis. At the same time, the conjunctiva and cornea become inflamed. Photophobia, sensation of a foreign body, pain and cramps in the affected area are found. Patients complain of fog in the eyes, blurred vision, fatigue during visual stress. Possible swelling of the eyelids, hyperthermia, cephalalgia, regional lymphadenitis.
- Keratitis. The picture includes intense pain, lacrimation, intolerance to bright light, blepharospasm, foreign body sensation, decreased vision. The cornea becomes cloudy.
- Uveitis. Photophobia is more pronounced in the acute form of the disease. Redness, blurred vision, narrowing of the pupil are observed. In chronic uveitis, the symptoms are smoothed, the disorder is mild or absent.
- Irit. The first manifestations are discomfort and increased lacrimation. Gradual progression with the addition of hyperemia, iris edema, pain syndrome, photophobia is characteristic. Sometimes the pathology debuts with a change in color or hemorrhages in the iris.
- Iridocyclitis. In most cases, the lesion is unilateral. The disease manifests itself as diffuse hyperemia of the eye, pain, aggravated by pressure on the eyeball. A slight decrease in visual acuity, lacrimation, "fog" before the eyes are revealed.
Non-inflammatory eye lesions
Photophobia is accompanied by dry eye syndrome. Pathology is often provoked by prolonged work at the computer, improper selection and use of contact lenses. It develops in some ophthalmic, autoimmune, endocrine, nephrological, hematological diseases. The clinical picture includes cramps, pain, a feeling of sand, blurred vision, fatigue.
The first symptom of a corneal ulcer is progressive pain, which is accompanied by photophobia, blepharospasm, eyelid edema, and lacrimation. In people with aniridia (absence of the iris), photophobia persists throughout life, supplemented by nystagmus and strabismus.
Violation can also occur with mechanical damage to the eyes. In patients with contusion of the iris, it is caused by traumatic mydriasis due to paresis of the sphincter. The pupil is dilated, the patient complains of blurred vision and photophobia. Possible damage to the vessels of the iris, the formation of hyphema.
Diagnostics
If a neurological pathology is suspected, patients are referred to a neurologist. Patients with eye diseases are examined by an ophthalmologist. In case of acute infections, depending on the type of lesion, consultation of a therapist, infectious disease specialist or otolaryngologist is required. The specialist finds out the nature, circumstances of the appearance and duration of photophobia, establishes a connection between the symptom and external factors. The examination program involves the following diagnostic procedures:
- Neurological examination. There are no changes in primary headaches and abusive cephalalgia. Patients with strokes and MIMC may show facial distortion, speech problems, signs of hemiparesis, apraxia, aphasia, vestibular ataxia, and other disorders. With meningitis, meningeal symptoms come to the fore. With encephalitis, cerebral manifestations are determined, sometimes signs of a focal lesion.
- Ophthalmological examination. During the examination, edema and hyperemia of the eyelids and conjunctiva, corneal syndrome, signs of damage to the iris, and other changes can be detected. Patients undergo visometry, perimetry, gonioscopy, biomicroscopy, measurement of intraocular pressure. Depending on the characteristics of the pathology, synechia, edema or retinal detachment, and other changes are noted.
- Ultrasonography. In neurological diseases, echoencephalography is performed to determine the displacement of median structures. To exclude vascular diseases or assess cerebral blood flow, patients with cephalalgia and disorders of cerebral circulation undergo dopplerography or duplex scanning of cerebral vessels. With iritis and uveitis, ultrasound of the eye is performed.
- Other instrumental methods. Patients with stroke require an urgent MRI or CT scan of the brain to clarify the volume and localization of the damaged area, to determine the tactics of treatment. MRI angiography may be indicated. With NMC and neurological diseases of inflammatory origin, a lumbar puncture is performed. If the eyes are affected, angiography of the retinal vessels, electroretinography, and other procedures can be performed.
- Laboratory tests. When examining the cerebrospinal fluid of patients with hemorrhagic stroke, blood impurities are determined, with meningitis, encephalitis, the cerebrospinal fluid may be cloudy, during microscopy, pleocytosis and an increase in protein levels are detected. For strokes, a general laboratory examination (UAC, OAM, BAC) is prescribed to clarify the cause of the pathology. In eye diseases, in some cases, a microbiological examination of the discharge is performed to establish the pathogen.
Ophthalmic examination
Treatment
Help at the prehospital stage
Patients with cephalgia are advised to stay in a shaded room. For influenza and SARS, rest, symptomatic agents (antipyretic, expectorant drugs, nasal drops) are indicated. Patients with ophthalmic pathologies are advised to reduce visual load, sometimes - to use dark glasses. Suspicion of a stroke, meningitis, encephalitis, brain abscess or rabies is a reason to call an ambulance immediately.
Conservative therapy
The plan of therapeutic measures is drawn up taking into account the cause of photophobia:
- Cephalgia. Analgesics are used to stop migraine attacks, and triptans are used for protracted paroxysms. For tension pains, NSAIDs, antidepressants, muscle relaxants, manual therapy, acupuncture, relaxation techniques, biofeedback are indicated. In severe cases, blockade of the occipital nerve is performed. Patients with abusive cephalgia cancel analgesics, prescribe antidepressants and anticonvulsants, less often - antipsychotics.
- Inflammatory diseases of the CNS. Emergency hospitalization required. Parenteral injections of antibiotics and sulfonamides are required. In severe cases, antibiotics are administered intralumbally. Symptomatic and restorative therapy is carried out, diuretics and corticosteroids are used if indicated.
- Stroke. Along with emergency surgical measures aimed at removing obstructions to blood flow and restoring blood supply, symptomatic therapy is carried out. Anticonvulsants, neuroprotectors, NSAIDs, antiemetics, sedatives are used. Complications are prevented.
- Acute infections. Depending on the type of pathogen, antiviral or antibacterial drugs are prescribed. Apply antipyretics, vitamins, drugs with antihistamine action, bronchodilators, local vasoconstrictor drugs. A severe course is considered as an indication for detoxification by infusion therapy against the background of forced diuresis.
- Inflammatory pathologies of the eyes. Antibacterial, antifungal or antiviral agents of general and local action, immunomodulators, cytostatics, antihistamines, NSAIDs may be recommended. According to indications, subconjunctival, parabulbar, intravitreal and subtenon injections are performed.
- Noninflammatory eye diseases. With xerophthalmia, artificial tear preparations, anti-inflammatory and immunotropic agents are used. Corneal ulcers are extinguished with tincture of iodine or brilliant green. Carry out therapy aimed at eliminating the pathogen. Mydriatics, immunomodulators, anti-allergic, anti-inflammatory and metabolic drugs are used. At the stage of cleansing the ulcer, physiotherapy is recommended.
Surgery
In diseases accompanied by photophobia, the following operations are performed:
- Cerebral abscess: drainage, stereotaxic aspiration.
- Stroke: external ventricular drainage, decompressive craniotomy, thrombolysis, stereotaxic hematoma aspiration.
- Uveitis, corneal ulcers: vitrectomy, layered or penetrating keratoplasty, excimer laser scar removal.