Diagnostic Dilemma of Painful Red Eye With Severe Headache
Dr Sunil Kumar, FRCS, MS, Mohamad Dossary Hospital, Department of Ophthalmology. PO BOX 335, Al Khobar 31952, Saudi Arabia.
Traditionally, the differential diagnosis of non traumatic painful red eye is limited to microbial keratitis, acute congestive glaucoma & acute iritis. However, if painful red eye is associated with headache, then migraine, sinusitis, orbital infection and inflammation are the usual differential diagnoses. Cluster headache as a cause of painful red eye with severe headache may be missed both by internists as well as by ophthalmologists.
I report two cases initially diagnosed, investigated and treated variously as glaucoma, partial third nerve paresis due to diabetes and meningitis. The correct diagnosis became apparent when all investigations were normal and the patient did not respond to treatment appropriate for the initial, presumed diagnoses. These cases emphasize the importance of a high index of suspicion for cluster headache, and the dramatic response to corticosteroid therapy in this usually overlooked malady.