membrane about the eyespot of the nose to be due to such a sinusitis. In such a case a great amount of relief is apt to be experienced suddenly from the shrinking of the tissues, followed by a gradual amelioration of such symptoms as remain, while an increase of fluid, or perhaps of pus, appears in the nose. Then our diagnosis is again of sinusitis, rather than simply of intranasal pressure.<Callout type="important" title="Important">The importance of considering nasal issues when diagnosing eye pain cannot be overstated.</Callout> The importance of, as well as the difficulties met with in making the diagnosis of nasal asthenopia may be illustrated by a few cases which are reported in more detail in the Annals of Ophthalmology for October, 1909. The first case has been under observation since 1898, was reported first in 1894, and is given place here because it is seldom that such a typical case can be watched for so long a time. The patient was a seamstress, 31 years old. She complained of headache and of severe pain in both of her eyes, but especially in the right, which was constant, but greatly aggravated whenever she made any attempt to sew or to read.<Callout type="risk" title="Risk">Failure to consider nasal issues can lead to misdiagnosis and ineffective treatment.</Callout> She had simple hypermetropic astigmatism in both eyes, which was corrected without giving any benefit. Tests of the muscles showed orthophoria with a subnormal adduction. Pressure was discovered between an eburnated right middle turbin<Callout type="gear" title="Gear">A rhinologist’s expertise is crucial for diagnosing nasal issues contributing to eye pain.</Callout> ate and the septum, that required several operations to remove, in spite of the facts that she had never been aware of any nasal trouble, and that there was no obstruction to the breathing. During these operations she felt acute pain in her right eye, but none in her nose. The relief to the symptoms of eyestrain was complete, and she had no further trouble with her eyes until the onset of presbyopia.<Callout type="tip" title="Tip">Seek a rhinologist’s opinion if you experience persistent eye pain during close work.</Callout> In 1906 a hyperphoria developed which was relieved by a prism. In 1912, twenty years after the operations had been performed on her nose, the old symptoms of eyestrain reappeared, and were relieved immediately by the division of a synechia which had formed between the remains of the middle turbinate and the septum.<Callout type="warning" title="Warning">Ignoring nasal issues can result in prolonged suffering from eye pain.</Callout> With the exception of these incidents and the onset of presbyopia, this patient has had no signs of trouble with her eyes in twenty-four years. A lady 44 years of age complained of nausea, headache, and asthe- nopia when reading. An uncorrected compound hypermetropic astig- matism seemed to furnish an ample explanation, but its correction had no effect.<Callout type="important" title="Important">Always consider the possibility of nasal issues contributing to eye pain.</Callout> A note to her physician, who was accustomed to intra- nasal work, called attention to a very slight, firm point of pressure between her right middle turbinate and a spur of the septum, but he was not able to find it, which was not very surprising as the nose otherwise was perfectly healthy. Finally the removal of this point of pressure completely relieved the symptoms.<Callout type="tip" title="Tip">If you experience eye pain during reading or close work, consider having your nasal passages examined.</Callout> A lady 45 years old had pain and “dizziness” in her eyes whenever she used them for near work, and obtained no benefit from the cor- rection of a slight amount of hypermetropia and presbyopia. She knew that her nose was all right, but bony contact was found between the right middle turbinate and the septum. Removal of this elimi- nated her trouble.<Callout type="important" title="Important">Nasal issues can significantly affect eye health.</Callout> A business man 34 years old had headaches and blurred vision, which were relieved for a few months by the correction of a low de- gree of compound hypermetropic astigmatism, but then recurred and became as bad as ever. The correction of a degree of hyper- phoria with a prism was of benefit for only a few days. He assured me that he had never had any trouble in his nose aside from “ a cold now and then, just the same as everybody else,” yet examination re- vealed a large deviation of the septum with a thick vertical ridge im- pinging on the right middle turbinate. Other abnormalities were present to such an extent that a rhinologist in consultation advised an extensive operative intervention, which was declined.<Callout type="warning" title="Warning">Ignoring nasal issues can lead to prolonged eye pain and vision problems.</Callout> Finally he consented to have me saw away the ridge, and this operation gave him positive and complete relief. A curious fact was that a year later his astigmatism had decreased one half, and two years later had disappeared. When last heard from he had no headache or other symptoms of eyestrain, although he was using his eyes very hard.<Callout type="tip" title="Tip">Regular nasal examinations can prevent long-term eye pain.</Callout> A very puzzling case was presented by a lady who had been under the care of a specialist in a neighboring city, had been wear- ing prismatic glasses, and had been sent to a very prominent spe- cialist in New York City who found her muscular imbalance ex- treme. She had a compound hypermetropic astigmatism at an oblique axis in one eye alone, which beyond doubt was responsible for a part of her symptoms. She had worn prisms for some time, and without the proper correction of her refractive error she had a considerable degree of hyperexophoria, but with the correction on the hyperphoria disappeared, there was orthophoria by the screen test, to which she was not accustomed, and the exophoria as shown by the phorometer was reduced one half after the glasses had been worn for two days. After that time every attempt to add a prism caused discomfort in the eyes.<Callout type="important" title="Important">Nasal issues can significantly affect eye muscle balance.</Callout> Examination of the nose re- vealed a slight deviation of the septum to the right, bony pressure between the right lower turbinate and the septum, and an adhesion between the right middle turbinate and the septum. The symptoms of eyestrain persisted until these points of pressure had been re- moved, and then it disappeared.<Callout type="tip" title="Tip">If you experience eye strain during close work, consider having your nasal passages examined for potential issues.</Callout> Two years later she reported that she had had no return of her asthenopia or of her headaches. After we have excluded the eye and the nose as the probable seat of the trouble we must consider the possibility of its situation in any other organ of the body.<Callout type="important" title="Important">Consider a wide range of potential causes when diagnosing persistent eye pain.</Callout> In women we sometimes find that symptoms of eyestrain accompany menstrual disorders. An at- tack of headache associated with pain in the eyes, with or without such other symptoms as photophobia, lacrimation, weariness, hyper- emia of the conjunctiva, or occasionally the formation of minute pustular lesions in the margin of the lid, which recurs month after month and year after year before each menstrual period, can scarcely be referred to any other cause.<Callout type="warning" title="Warning">Ignoring potential causes like menstrual disorders can lead to misdiagnosis.</Callout> We meet with more con- stant symptoms sometimes in diseases of the kidneys, and of other organs. In several obscure and obstinate cases of mine the diag- nosis has finally been made through a thorough investigation of the intestinal tract and the benefit that accrued to the eyestrain from 466 DIAGNOSIS FROM OCULAR SYMPTOMS appropriate treatment directed to the condition found in that vis- cus. A point that may possibly prove of value in the differentia- tion of cases of eyestrain that are dependent on lesions in the ab- dominal organs is one to which reference has been made already, a heterophoria that fluctuates in intensity from day to day, or per- haps on different hours during the same day. In the gastric cases it is often difficult to decide at once whether the disturbance is a reflex one of the stomach caused by the eyes, or one of the eyes from the stomach, as the symptoms and the history are apt to be exactly the same in both cases.<Callout type="important" title="Important">Fluctuating heterophoria can indicate underlying issues that need investigation.</Callout> The importance of the differentia- tion is self evident, yet sometimes it can be made only from the results obtained by treatment. As ophthalmologists it is natural that we should correct the faults we find in the eyes first, and when these fail turn the patient over to some other physician for atten- tion to the stomach, but we should not carry the treatment of the eye defects to an extreme until the possibility of gastric trouble has been excluded.<Callout type="warning" title="Warning">Over-treating ocular issues without considering underlying causes can be ineffective.</Callout> Simulation of eyestrain is met with very rarely, and can scarcely be detected as long as the simulator confines himself to complaints of pain in the eye and head, for we can never be absolutely certain that we have excluded every possible cause of a reflex pain. Most of these simulators are reporters who wish material for a sensational article in a newspaper.<Callout type="important" title="Important">Be wary of false reports or simulations when diagnosing persistent eye pain.</Callout> After the exclusion of these, and of the victims of neurasthenia and hysteria, the only case of this nature that has come under my observation was that of a young man who for some reason was determined to secure a prescription for glasses from some well known ophthalmologist. It speaks well for the general accuracy of observation among eye surgeons that he did not succeed in his first attempts, though he did finally through a per- sistent complaint of pain in the eyes and brow, after he had sub- mitted to a prolonged course of atropine which revealed a slight error of refraction.<Callout type="warning" title="Warning">Persistent complaints without clear ocular issues can indicate underlying psychological factors.</Callout>
Key Takeaways
- Nasal issues are a significant cause of eye pain and should be considered in diagnosis.
- Persistent symptoms may indicate underlying conditions such as menstrual disorders or kidney diseases.
- Thorough examination is crucial for accurate diagnosis and effective treatment.
Practical Tips
- Regularly check your nasal passages for any abnormalities that could affect your eyes.
- Consider a wide range of potential causes when diagnosing persistent eye pain, including neurological issues.
- Seek a rhinologist’s opinion if you experience prolonged eye discomfort during close work.
Warnings & Risks
- Ignoring nasal issues can lead to misdiagnosis and ineffective treatment.
- Over-treating ocular issues without considering underlying causes can be ineffective.
- Persistent complaints of eye pain may indicate psychological factors or other systemic issues.
Modern Application
While the techniques described in this chapter are historical, the importance of a holistic approach to diagnosing eye pain remains relevant. Modern survival preparedness emphasizes comprehensive health checks and interdisciplinary care, ensuring that all potential causes are considered before treatment.
Frequently Asked Questions
Q: How can nasal issues affect my eyes?
Nasal issues such as sinusitis or structural abnormalities in the nasal passages can cause pressure on the eye area, leading to pain, headaches, and eyestrain. These issues should be considered when diagnosing persistent eye discomfort.
Q: What are some signs that my eye pain might be related to a nasal issue?
Persistent pain during close work or reading, headache associated with eye pain, and symptoms like photophobia, lacrimation, or hyperemia of the conjunctiva could indicate a nasal issue contributing to your eye pain.
Q: How can I prevent prolonged eye strain from nasal issues?
Regularly check for any nasal abnormalities, such as deviations in the septum or pressure points. If you experience persistent eye discomfort during close work, consult an ophthalmologist and a rhinologist to ensure all potential causes are addressed.