Ophthalmologic aspects of headache in children

Abstract

Headaches are common in children and adolescents and are occasionally due to eye conditions. The most common ophthalmic causes are refractive error, impairment of accommodation or convergence, ocular surface disease, acute glaucoma, optic neuritis, scleritis, uveitis, and orbital conditions.Headache caused by ocular refractive error is generally symptomatic after prolonged visual tasks. The pain in the eye with accompanying headache, which characteristically gets worse after visual tasks such as prolonged screen use or reading, may be caused by the ocular surface disorder.

Headaches that are triggered by dark light should raise suspicions of angle closure glaucoma. Scleral or uveal inflammatory diseases are usually associated with severe, aching, or throbbing ocular pain and photophobia. Examination often reveals redness of the eye. Optic neuritis in children is frequently bilateral, with optic nerve swelling and a very low visual acuity.

Orbital conditions that can cause headaches include preseptal cellulitis, which produces eyelid edema, inflammation, and erythema. Orbital cellulitis also causes restriction and pain in eye movement, exophthalmos, chemosis, reduced visual function, and a relative afferent pupillary defect. Other orbital conditions that can cause headaches are inflammatory diseases, vascular malformations, and orbital masses. Many other headache causes can present with ocular symptoms, such as elevated intracranial pressure from an intracranial process. Ophthalmologic examination can be helpful in some of these cases.

Therefore, cooperation with the neurologist and other specialists is essential.