Chronic headache & eye strain

[cbx]

Hello

I'm a 32 year old male living in the UK, and having been suffering from chronic problems with what I believe to be eye strain causing discomfort, leading to headache (frontal), light sensitivity with some general eye soreness for about 6 months.

I've been to see my doctor, optometrist and also and ophthalmologist all who haven't been able to help.  The optomotrist did indicate that I have a decompenstated esophoria at near however, and given my glasses for use with the computer with the following prescription:

Sphere Cylinder Axis VA Add Near

R -0.25 +0.75 85 6/7.5+2       +0.25 N5
L -0.25 +0.50 87.5 6/6 +0.25   N5

These haven't really helped, and I still often feel the need to go to bed when I get home from work - simply because I feel strain and pain in the upper in corner of my eyes, towards the top of my nose.  When my eyes get very strained this effects seemingly last for days.  It's affecting my work (IT) and home life.

I'm currently trying patching my weaker right eye for a day or two to see if this is a fusional issue.

In your opinion, do you think the esophoria I've been diagnosed with could explain my problems?  Would a patch test indeed be diagnostically helpful?  Any other general advice or tests I can perform to hopefully rid me of this quality of life robbing problem?

Many thanks for any advice.

[aclem]

Disclaimer: I'm an optometry student; not a doctor's opinion.

Esophores do experience painful headaches after excessive convergence for a long period of time.  I agree with the MD that you should see if vision training could be an option for you (it has worked out great for my exophoria, though my symptoms were not as severe).  I also agree that you should consider seeing an optometrist or ophthalmologist to get prism prescribed in your glasses to alleviate the extraocular muscles from straining due to your convergence (this most likely gets done during a vision therapy session rather than a yearly eye exam).

I know I'm just repeating what the doctor mentioned but it's important you figure this out as soon as you can; we don't want you in pain if someone can help!

[JRV80]

Hey
I have the same symptoms as you except may be a little worse, I had to give up my job in IT due to the pain. I've recently discovered I can use a projector as I don't have to focus my eyes so much and I can deal with the pain.
I am slightly long-sighted in both eyes and wear the corresponding glasses. I've seen 2 ophthalmologist who say my eyes are fine and 4 neurologists who are stumped and an MRI scan of my brain. All negative.
Perhaps we could pool our resources to get a cure for our problems

Jack

[cbx]

Thanks very much for the reply.

I can confirm I don't have any blurred vision.  The patch test I carried out (patching my right eye for a day) did seem to alleviate my problems in a very marked way.  I assume this is because my eyes weren't straining to maintain fusion.

I have been diagnosed with esophoria at near.  Doesn't this mean the same thing as convergence excess esophoria?  Does it not potentially explain the chronic symptoms I'm experiencing?

I'm aware of dry eye and CVS, and it's true that sometimes my eye's get sore (i.e. surface discomfort/pain).  However, I've used drops and gel (as suggested by the ophthalmologist I saw), and this didn't really have effect.  In addition, under patch test conditions, my uncovered eye didn't get sore which I would have normally expected it to (every day this week it had).

I probably sound like a patient who is self convinced of his own self-diagnosis that isn't based on proper training and experience but rather questionable Internet reference - a danger I'm aware of.  I'm open to help from the experts but I just haven't seen any results thus far.

I've seen people of the 3 professions that should have helped (in the UK this is optometrist, ophthalmologist and general doctor) without progress - I think I may give a different optometrist a try as my problems may potentially be helped by refractive measures.  That said, any additional views you'd have would be most welcome.

[Michael J Kutryb, MD]

I see no diagnostic or therapeutic benefit for patching - so I would forget about that.  I've heard you mention headache, eye soreness, and light sensitivity - but never did you mention blured vision.  This makes me wonder if your problems are not so much from fusional problems but perhaps rather related to dry eyes aggrevated by long bouts of computer use.  I think that should be looked into.  Other than that - your ophthalmologist should be able to tell if you have convergeance insuffiency or convergeance excess or an  esophoria and possibly prescribe exercises or glasses with prism.  Perhaps you shoudl see an pediatric ophthalmologist if you truly have some type of fusional problem.

Michael Kutryb, MD