What are the most effective ways to manage chronic eye pain?

Question

Hello doctor,

Last year, I developed a tic in my right eye, which caused me to blink forcefully throughout the day. This tic persisted for five months. To alleviate it, I began practicing yoga, meditation, and breathing exercises. However, I have since been experiencing chronic pain in my right eye, along with difficulty in moving it. I consulted several ophthalmologists, all of whom found my eyes to be clinically normal. One recommended a CT scan and MRI, which both showed normal results. He suggested retrobulbar neuritis as a possible diagnosis by exclusion and prescribed Prednisolone, which I took only once.

I later consulted two neurologists. The first prescribed an antidepressant, which I took for one month without significant improvement. The second neurologist recommended another MRI with contrast, which also came back normal, showing that the eye muscles and nerves were intact. However, this neurologist referred me to an ENT specialist due to mucosal thickening in my right maxillary sinus, as they thought it could be a contributing factor.

The ENT specialist explained that the mucosal thickening, which appeared to be a cyst, was unlikely to be the cause of my eye pain, as the two areas were far apart. I am scheduled to have the cyst removed in the coming weeks. For my eye pain and difficulty with movement, the ENT specialist prescribed the following medications: Duloxetine for two months, Pregabalin for one month, Topiramate for three months, and Magnesium for three months.

After researching these medications, I am concerned about their side effects and wonder if it is safe to take them together. I would appreciate clarification on my condition, its treatment options, and whether these medications can be taken simultaneously without adverse effects. I am not diabetic, nor do I have hypertension. I am physically active and otherwise healthy.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on your description, you have right eye pain, and it seems to extend beyond the eye to the area behind it. I would like to know more details about the nature of the pain, such as whether it feels like pressure, throbbing, continuous, or severe. The good news is that you have already undergone thorough investigations, and local ocular diseases have been ruled out. Additionally, your CT (computed tomography) scan and MRI (magnetic resonance imaging) did not reveal any abnormalities, and an ENT (ear, nose, and throat) evaluation has also been completed.

At this point, we are likely dealing with neurogenic pain, which is most probably the underlying cause. This pain could be related to a migraine or, in rare cases, temporal arteritis (inflammation of the blood vessels in the temporal region). An ESR (erythrocyte sedimentation rate) test can help rule out temporal arteritis. Tablet Duloxetine may help alleviate the pain, and I recommend continuing it for at least four weeks before considering other options.

I suggest you keep a record of the severity, duration, nature, and frequency of the pain to assist in future evaluations. For now, please continue with your current treatment and review your progress in two to three weeks.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

It is good that your ESR results are normal, which helps rule out trigeminal neuritis (an inflammatory or autoimmune condition affecting certain branches of the trigeminal nerve). Based on this, I suggest discontinuing Pregabalin and continuing with Duloxetine and Topiramate. We can reassess your condition after a month or sooner if necessary. At this point, there is no cause for concern regarding your illness, so you can safely proceed with this treatment plan. It is also encouraging that you remain physically active, as regular exercise is generally beneficial.

I hope this helps you.

Thanks for using icliniq, and have a nice day.