Pain
Chat Highlights
April 26, 2006

On Wednesday, April 26, 2006, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Pain."

Moderator:  Welcome, Dr. Wilson. Tonight our topic concerns pain, which seems to take many forms.  

Dr. Rick Wilson:  Yes, many. There's surface pain - -sharp, sore, scratchy, unbearable with light sensitivity,  etc.  There is a pain that seems like it comes from the center of the eye and is often an ache.  Many people have a sharp, but quick, pain that seems like someone is sticking a hatpin in their eye and pulling it right out.  I have that kind of pain occasionally, which seems like a spasm of the muscle in the eye.  Then there is a pain behind the eye that often is more dull than sharp.  Does anyone have a different kind of pain than I have described?

P:  You described my type of pain exactly:  A sore pain that comes and goes.

P:  Yes, I often feel like my eye is being squeezed.

Moderator:  Many days I have an eye ache that seems to be off center, and sometimes my eye feels as if it's in a vise grip. 

P:  Occasionally I have a quick, sharp pain. 

Dr. Rick Wilson:  That is what I was trying to describe with the hatpin example; sharp but over quickly.

P:  Is that because the eye is dry?

Dr. Rick Wilson:  Dry eye usually causes a sandy, irritated eye.  Dry eye can also make you feel sleepy, because you want to close your  eyes all the time to try to prevent the evaporation  of tears off the cornea.

P:  So irritated eyes don't necessarily mean increased IOP (intraocular pressure)?

Dr. Rick Wilson:  That's correct. 

P:  Do your glaucoma patients often complain about pain? 

Dr. Rick Wilson:  No, pain is usually only seen with acute angle- closure glaucoma or some of the secondary glaucomas.  I see people in pain, but often the pain is caused by a corneal ulcer, iritis or some other condition.

P: Can a person have high IOP without pain?   

Dr. Rick Wilson:  It is not unusual to see patients who have blind eyes with IOPs of 70 mm Hg who have no discomfort.  If the pressure has been 4 mm Hg for some months and suddenly rises to 20 mm HG, that will cause pain.  Likewise, a slow rise to 50 mm Hg will be painless, but a quick rise to 35 mm Hg will be painful.

P:  Does the type of pain help the doctor determine the cause?

Dr. Rick Wilson:  Yes, the type of pain (dull, sharp, constant, intermittent, occasional), the time of day the pain occurs, and whether it is brought on by activities help determine the cause. 

P:  Do patients who have had several laser and surgical procedures complain about pain?  I have had many such procedures and have chronic eye pain.  

Dr. Rick Wilson:  Certainly the more eye surgeries you have had, the more likely you are to have an irritated eye, but that's not always necessarily so.

P:  Do any or all of the glaucoma surgeries produce post-surgical eye pain?

Dr. Rick Wilson:  Most glaucoma surgeries are not painful, since no muscles are cut, but the tiny 10-0 nylon suture knots can irritate the eye.

P:  Which glaucoma surgeries are painful?

Dr. Rick Wilson:  Shunts, because they involve more manipulation of the eye, and the extraocular muscles are more painful. Cyclodestructive procedures, such as cyclophotocoagulation and cyclo-cryotherapy,  are seriously painful, since they try to destroy part of the ciliary body, the part of the eye that makes the fluid.

P:  If a tooth hurts when its nerve is damaged, why doesn't the optic nerve hurt when it is damaged.  Is that because there are no sensors to transmit the pain?  

Dr. Rick Wilson:  Correct.

P:  A neurologist once told me that I may have chronic eye pain because a nerve was hit during surgery.   

Dr.  Rick Wilson:  The nerves can be hit by the needle carrying the local anesthetic, or the anesthetic could be toxic to the nerve, disturbing its function for many months.

P:  You mentioned secondary glaucomas as a cause of pain.  Would my ICE (iridio-corneal endothelial syndrome) be the cause of sore, achy pain that comes and goes for several months at a time?  I never bothered to mention it to my doctor, because my eye was never red or irritated and my vision didn't change.

Dr. Rick Wilson:  I would think so.

P:  Is sudden pain coming from temporal areas a sign the IOP has increased?  

Dr. Rick Wilson:  That is not an accurate sign that the IOP has changed.  However, temporal giant cell arteritis can cause unremitting temporal pain.  

P:  What is temporal giant cell arteritis?

Dr. Rick Wilson:  It is an inflammation of the arteries around the body.  Patients with temporal arteritis need to be well-cared for.

P:  Sometimes I'll get a throbbing headache on only the right side (surgery eye), from my right ear forward.  Could the surgery site just be irritated from whatever else is going? 

Dr. Rick Wilson:  That sounds unusual to be coming from your eyes.  Clearly you need to continue to investigate that.

P:  A sub-acute attack can trigger pain and nausea.  Is it known why?

Dr. Rick Wilson:  An acute rise in eye pressure may interfere with blood circulation that could cause ischemia and a secondary pain.

P:  Whenever I cry, my eyes really ache afterwards. The pain from crying has only happened in the last couple of years.  Is that caused by aging or elevated eye pressure? 

Dr. Rick Wilson:  It's somewhat related to age, undoubtedly, but not necessarily related.

P:  My father had pan retinal photocoagulation done today, as well as some freezing.  Will he have much pain?  So far, he seems to be okay. 

Dr. Rick Wilson:  I doubt it, but I do not know for sure.  If he doesn't have pain tomorrow, it is unlikely to show up days after the laser.

P:  Would you please provide a brief description of pan retinal photocoagulation?

Dr. Rick Wilson:  With neovascular glaucoma, the retina has such poor circulation that it is sending out a message to the body, imploring it to send it more blood supply. The body builds vessels in response to the chemical mediator, but they are leaky vessels that grow into the drain of the eye and block the drain.  To stop the neovasculargenic factor from affecting the eye, the doctor  uses the laser to kill the retina that is sending out the message.  The dead retina stops sending out the message. 

P:  If a part of my iris was removed during a trabeculectomy, could that be causing pain?  

Dr. Rick Wilson:  Yes, that is a big destructive procedure, so I would expect some pain, especially from where the probes were.

Moderator:  Dr. Wilson, that is all for this evening.  Thank you for your time.  Have a safe trip! 

On May 3, Dr. Thomas discussed "Pigment Dispersion Syndrome and Pigmentary Glaucoma" in the Chat room. Click here for highlights of that meeting.

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