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Neurology Nov 2020The majority of patients with traumatic brain injury (TBI) are classified as having a mild TBI. Despite being categorized as mild, these individuals report ongoing and... (Review)
Review
The majority of patients with traumatic brain injury (TBI) are classified as having a mild TBI. Despite being categorized as mild, these individuals report ongoing and complex symptoms, which negatively affect their ability to complete activities of daily living and overall quality of life. Some of the major symptoms include anxiety, depression, sleep problems, headaches, light sensitivity, and difficulty reading. The root cause for these symptoms is under investigation by many in the field. Of interest, several of these symptoms such as headaches, ocular pain, light sensitivity, and sleep disturbances may overlap and share underlying circuitry influenced by the intrinsically photosensitive retinal ganglion cells (ipRGCs). These cells are light sensing, but non-image forming, and they influence corneal function, pupillary constriction, and circadian rhythm. In this review, we discuss these symptoms and propose a role of the ipRGCs as at least one underlying and unifying cause for such symptoms.
Topics: Animals; Brain Injuries, Traumatic; Humans; Photophobia; Retinal Ganglion Cells
PubMed: 32934170
DOI: 10.1212/WNL.0000000000010830 -
Romanian Journal of Ophthalmology 2016Pterygium is characterized by the thickening of the bulbar conjunctiva and the invasion of the cornea from the sclerocorneal limbus to the central portion of the cornea....
Pterygium is characterized by the thickening of the bulbar conjunctiva and the invasion of the cornea from the sclerocorneal limbus to the central portion of the cornea. Pterygium produces corneal deformation, which extends toward the central portion of the cornea. The visual disorders depend on the corneal extent. The treatment goal is the removal of the corneal and conjunctival portion of the pterygium and the coverage of the resulting conjunctival defect. The association of the pterygium surgical excision was assessed with conjunctival autograft. For this purpose, a retrospective study was performed on 68 patients and was extended over 7 years (2009-2015). Patients with recurrent pterygium were excluded. The time for corneal re-epithelization and for the pain and photophobia disappearance was followed. The incidence of recurrence was also observed. Pain levels were assessed by using a 10-point visual analog linear scale (VAS). The mean time for ocular pain and photophobia disappearance was of 48 hours. The mean pain score was 3.38 at 24 hours after surgery. Corneal re-epithelialization was achieved in 60 hours after surgery. Recurrence occurred in 6 patients. It was concluded that pterygium surgical excision with conjunctival autograft is effective in pterygium surgery.
Topics: Adult; Autografts; Conjunctiva; Epithelium, Corneal; Female; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Pterygium; Re-Epithelialization; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
PubMed: 29450343
DOI: No ID Found -
PloS One 2023The purpose of this cohort study was to investigate the association between the prevalence of abnormal ocular examination results and the common visual symptoms of eye...
PURPOSE
The purpose of this cohort study was to investigate the association between the prevalence of abnormal ocular examination results and the common visual symptoms of eye strain, blurred vision and photophobia.
METHODS
Consecutive first-visit outpatients with best-corrected visual acuity better than 20/30 in both eyes were enrolled and those with a history of intra-ocular lens implantation and glaucoma were excluded. Dry eye-related examinations and retinal thickness measurement were conducted. The odds ratio (OR) was calculated with logistic regression analyses of ocular data in relation to the presence of visual symptoms.
RESULTS
A total of 6078 patients (3920 women, mean age 49.0 ± 20.4 years) were analyzed. The prevalence of each symptom was 31.8% for eye strain, 22.5% for blurred vision and 16.0% for photophobia. A significant risk factor for eye strain was short tear break-up time (TBUT) (OR 1.88), superficial punctate keratitis (SPK) (OR 1.44), and thickness of ganglion cell complex (GCC) (OR 1.30). Risk factors for blurred vision were short TBUT (OR 1.85), SPK (OR 1.24) and GCC (OR 0.59). Risk factors for photophobia were short TBUT (OR 1.77) and SPK (OR 1.32). Schirmer test value, peripapillary nerve fiber layer thickness and full macular thickness were not associated with the tested symptoms.
CONCLUSION
The current study successfully identified female gender, short TBUT, and SPK as significant risk factors for eye strain, blurred vision, and photophobia with considerable ORs.
Topics: Humans; Female; Adult; Middle Aged; Aged; Photophobia; Cohort Studies; Retina; Dry Eye Syndromes; Glaucoma; Keratitis; Tomography, Optical Coherence
PubMed: 37862343
DOI: 10.1371/journal.pone.0293320 -
Scientific Reports Sep 2020Inherited retinal dystrophy (IRD) patients often experience photophobia. However, its mechanism has not been elucidated. This study aimed to investigate the main...
Inherited retinal dystrophy (IRD) patients often experience photophobia. However, its mechanism has not been elucidated. This study aimed to investigate the main wavelength of light causing photophobia in IRD and difference among patients with different phenotypes. Forty-seven retinitis pigmentosa (RP) and 22 cone-rod dystrophy (CRD) patients were prospectively recruited. We designed two tinted glasses: short wavelength filtering (SWF) glasses and middle wavelength filtering (MWF) glasses. We classified photophobia into three types: (A) white out, (B) bright glare, and (C) ocular pain. Patients were asked to assign scores between one (not at all) and five (totally applicable) for each symptom with and without glasses. In patients with RP, photophobia was better relieved with SWF glasses {"white out" (p < 0.01) and "ocular pain" (p = 0.013)}. In CRD patients, there was no significant difference in the improvement wearing two glasses (p = 0.247-1.0). All RP patients who preferred MWF glasses had Bull's eye maculopathy. Meanwhile, only 15% of patients who preferred SWF glasses had the finding (p < 0.001). Photophobia is primarily caused by short wavelength light in many patients with IRD. However, the wavelength responsible for photophobia vary depending on the disease and probably vary according to the pathological condition.
Topics: Electroretinography; Humans; Light; Photophobia; Retinal Dystrophies; Retinitis Pigmentosa; Visual Acuity
PubMed: 32908200
DOI: 10.1038/s41598-020-71707-2 -
Case Reports in Otolaryngology 2016We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy...
We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy for 4 months and successfully with a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy which improved her mood and the tolerance for sounds and light.
PubMed: 26981300
DOI: 10.1155/2016/2570107 -
Cureus Nov 2021Iatrogenic pneumocephalus and dural puncture are some causes of headache following cervical epidural injection. A 50-year-old woman presented with a sharp headache at...
Iatrogenic pneumocephalus and dural puncture are some causes of headache following cervical epidural injection. A 50-year-old woman presented with a sharp headache at the base of her skull following a cervical epidural injection for chronic neck pain. It was not relieved by lying down and was associated with nausea, vomiting, and photophobia without fever or neck rigidity. Neurological examination failed to show any abnormalities. A head CT scan showed newly evident pneumocephalus in the ventricular system and the extra-axial subarachnoid space within the sulci of the right frontal lobe. Oxygen supplementation was started with the help of a non-rebreather mask connected to 15 liters of oxygen and was slowly down titrated to room air. Repeat CT scan of the head after 48 hours showed complete resolution of the intracranial pneumocephalus. Normobaric oxygen therapy via a non-rebreather mask and a high-flow nasal cannula is effective for the treatment of intracranial pneumocephalus.
PubMed: 34963846
DOI: 10.7759/cureus.19830 -
Frontiers in Neurology 2023Narrow band green light (NbGL) has been shown to relieve headache in small numbers of subjects but large-scale real-world assessments are lacking. The goal of this...
BACKGROUND
Narrow band green light (NbGL) has been shown to relieve headache in small numbers of subjects but large-scale real-world assessments are lacking. The goal of this prospective, observational, open-label, real world study was to determine whether treatment with NbGL during the ictal phase of migraine, improves patients' perception of their headache, photophobia, anxiety and same-night sleep.
METHODS
The study was conducted in purchasers of the NbGL Lamp in two phases. In Phase I purchasers of the Lamp completed a survey and were asked to participate in a 6-week diary study. In Phase 2 participants completed daily diaries for 6 weeks. Specifically, they were asked to use their judgement/impression/perception when choosing between headache-improved or headache-unimproved after using the NbGL during acute attacks. Diary outcomes of interest included rates of attacks improve in responders (≥50%), non-responders (<50%), super-responders (≥75%), and super non-responders (<30%).
RESULTS
Of 3,875 purchasers of the Lamp for migraine, 698 (18%) agreed to participate, filled out a pre-study survey, and agreed to a 6-week daily headache diary. Complete data were provided by 181 (26%) participants. Using criteria above, 61, 39, 42, and 27% of participants were classified responder, non-responder, super-responder and super non-responder, respectively. Headache improved in 55% of all 3,232 attacks, in 82% of the 1,803 attacks treated by responders, and in 21% of the 1,429 attacks treated by non-responders. Photophobia improved in 53% of all attacks, 68% of the attacks in responders and in 35% of the attacks in non-responders. Anxiety improved in 34% of all attacks, 46% of the responders' attacks, and 18% of the non-responders' attacks. Sleep improved in 49% of all attacks, 59% of the responders' attacks, and 36% of the non-responders' attacks.
CONCLUSION
This open-label real world study suggests that 2 h of treatment with the lamp during migraine attacks is associated with relief of pain and photophobia, reduction in anxiety, and improved sleep. The absence of rigorous diagnosis and a blinded contemporaneous control group limits the rigor of this interpretation. Improvement in photophobia, anxiety and sleep among the responders may be secondary to the improvement in the headache itself.
CLINICAL TRIAL REGISTRATION
ClinicalTrial.gov (NCT04841083).
PubMed: 37859647
DOI: 10.3389/fneur.2023.1282236 -
Pediatric Research Nov 2021Benign paroxysmal torticollis (BPT) is characterized by attacks of head tilt associated with vomiting, irritability, and/or ataxia in early childhood. BPT is associated...
BACKGROUND
Benign paroxysmal torticollis (BPT) is characterized by attacks of head tilt associated with vomiting, irritability, and/or ataxia in early childhood. BPT is associated with migraine but risk factors are unknown. Impact on quality of life is also unknown.
METHODS
Parents/caregivers of children with ongoing or resolved BPT participated in telephone interviews (n = 73). Those with ongoing BPT completed the Infant Toddler Quality of Life questionnaire (ITQoL).
RESULTS
Median age of children at the time of interview was 2.9 years (range 0.25-23). BPT was ongoing in 52% (n = 38). Nineteen percent (n = 14) developed migraine (median age 9.25 years, range 2.5-23) and 63% (n = 46) developed another episodic syndrome associated with migraine. Proportion of patients who developed migraine was higher among those with certain migrainous symptoms during BPT attacks vs. those without: phonophobia (58 vs. 21%, p = 0.02), photophobia and phonophobia (55 vs. 23%, p = 0.05), and photophobia, phonophobia, and motion sensitivity (60 vs. 22%, p = 0.02). ITQoL results showed significant impact of BPT on quality of life.
CONCLUSIONS
Children with BPT may develop migraine or other episodic syndromes associated with migraine. Presence of migrainous features during BPT episodes may increase likelihood of developing migraine. Though characterized as "benign," BPT can significantly impact children and families.
IMPACT
Benign paroxysmal torticollis (BPT) is a rare condition of early childhood characterized by episodes of head tilt associated with vomiting, irritability, ataxia, pallor, and/or malaise. This cohort study describes the phenotypic spectrum of BPT, variable treatment, natural history and association with migraine, and impact on development and quality of life. Children with BPT may go on to develop migraine or episodic syndromes that may be associated with migraine; presence of migrainous features during attacks may increase odds of developing migraine. BPT can have significant impact on quality of life, demonstrated by findings from the Infant Toddler Quality of Life questionnaire.
Topics: Child; Child, Preschool; Cohort Studies; Humans; Migraine Disorders; Phenotype; Quality of Life; Surveys and Questionnaires; Torticollis
PubMed: 33564129
DOI: 10.1038/s41390-020-01309-1 -
Frontiers in Neuroscience 2023To examine the effect of botulinum toxin A (BoNT-A) on neural mechanisms underlying pain and photophobia using functional magnetic resonance imaging (fMRI) in...
INTRODUCTION
To examine the effect of botulinum toxin A (BoNT-A) on neural mechanisms underlying pain and photophobia using functional magnetic resonance imaging (fMRI) in individuals with chronic ocular pain.
METHODS
Twelve subjects with chronic ocular pain and light sensitivity were recruited from the Miami Veterans Affairs eye clinic. Inclusion criteria were: (1) chronic ocular pain; (2) presence of ocular pain over 1 week recall; and (3) presence of photophobia. All individuals underwent an ocular surface examination to capture tear parameters before and 4-6 weeks after BoNT-A injections. Using an event-related fMRI design, subjects were presented with light stimuli during two fMRI scans, once before and 4-6 weeks after BoNT-A injection. Light evoked unpleasantness ratings were reported by subjects after each scan. Whole brain blood oxygen level dependent (BOLD) responses to light stimuli were analyzed.
RESULTS
At baseline, all subjects reported unpleasantness with light stimulation (average: 70.8 ± 32.0). Four to six weeks after BoNT-A injection, unpleasantness scores decreased (48.1 ± 33.6), but the change was not significant. On an individual level, 50% of subjects had decreased unpleasantness ratings in response to light stimulation compared to baseline ("responders," = 6), while 50% had equivalent ( = 3) or increased ( = 3) unpleasantness ("non-responders"). At baseline, several differences were noted between responders and non-responders; responders had higher baseline unpleasantness ratings to light, higher symptoms of depression, and more frequent use of antidepressants and anxiolytics, compared to non-responders. Group analysis at baseline displayed light-evoked BOLD responses in bilateral primary somatosensory (S1), bilateral secondary somatosensory (S2), bilateral anterior insula, paracingulate gyrus, midcingulate cortex (MCC), bilateral frontal pole, bilateral cerebellar hemispheric lobule VI, vermis, bilateral cerebellar crus I and II, and visual cortices. BoNT-A injections significantly decreased light evoked BOLD responses in bilateral S1, S2 cortices, cerebellar hemispheric lobule VI, cerebellar crus I, and left cerebellar crus II. BoNT-A responders displayed activation of the spinal trigeminal nucleus at baseline where non-responders did not.
DISCUSSION
BoNT-A injections modulate light-evoked activation of pain-related brain systems and photophobia symptoms in some individuals with chronic ocular pain. These effects are associated with decreased activation in areas responsible for processing the sensory-discriminative, affective, dimensions, and motor responses to pain.
PubMed: 37404468
DOI: 10.3389/fnins.2023.1202341 -
Ear, Nose, & Throat Journal Apr 2023We present a case of malignant melanoma in the middle ear in a 63-year-old woman who presented with severe pain on the right side of her face and head, tinnitus,...
We present a case of malignant melanoma in the middle ear in a 63-year-old woman who presented with severe pain on the right side of her face and head, tinnitus, photophobia, and hemorrhagic discharge from the right ear, as well as right facial nerve paralysis. After more than two years of conservative treatment for otitis media and sclerotic mastoiditis, a pathologically enlarged lymph node on the right side of the neck appears. It is removed, and the histopathological examination reveals that it is metastatic malignant melanoma. Imaging examinations reveal a tumoral lesion in the middle ear with bone infiltration. The right middle ear is operated on, and the tissue sent for testing reveals melanoma. The patient was treated with Nivolumab after the operation and is now in sustainably good condition.
PubMed: 37017119
DOI: 10.1177/01455613231169454