Robblee Jennifer, Patel Jay N
Lewis Headache Clinic, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 240 W. Thomas Rd., Phoenix, AZ, 85013, USA.
Neuro-ophthalmology, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 240 W.Thomas Rd, AZ, 85013, Phoenix, USA.
Curr Neurol Neurosci Rep. 2025 Jul 12;25(1):48. doi: 10.1007/s11910-025-01436-4.
Eye pain is a common but diagnostically complex symptom. The underlying etiologies span neurologic, ophthalmologic, and systemic conditions that range from benign to vision- or life-threatening. This review aims to provide a neurologist-oriented approach to the differential diagnosis of eye pain, emphasizing clinical reasoning and red flag identification.
Ocular inflammation and surface disorders are commonly diagnosed etiologies for eye pain but neurologic disorders including primary headaches may be underrecognized sources of eye pain. Clinical clues like the pain description and location, patterns of visual disturbances, and other associated symptoms can guide diagnosis. Exam clues like optic disc edema, cranial nerve abnormalities, red eye pattern, ocular bruit, and intraocular pressure can guide localization and referral urgency. Integration of targeted history, key physical exam findings, and judicious use of investigations are critical for identifying vision- or life-threatening pathology. Using a focused history with targeted neurologic and ophthalmologic examinations, neurologists will be able to choose appropriate investigations and identify when urgent ophthalmology referral is required. This review outlines a systematic, symptom-based approach to eye pain so that neurologists can identify urgent conditions, improve diagnostic efficiency, and collaborate effectively with ophthalmology.
眼痛是一种常见但诊断复杂的症状。其潜在病因涵盖神经、眼科及全身疾病，范围从良性到威胁视力或生命。本综述旨在为神经科医生提供一种针对眼痛鉴别诊断的方法，重点强调临床推理和警示信号识别。
眼部炎症和表面疾病是眼痛常见的诊断病因，但包括原发性头痛在内的神经疾病可能是未被充分认识的眼痛来源。疼痛描述与位置、视觉障碍模式及其他相关症状等临床线索可指导诊断。视盘水肿、脑神经异常、眼红模式、眼部杂音及眼压等检查线索可指导定位及转诊紧迫性。整合有针对性的病史、关键体格检查结果以及合理运用检查手段对于识别威胁视力或生命的病变至关重要。通过聚焦病史及针对性神经和眼科检查，神经科医生将能够选择合适的检查，并确定何时需要紧急转诊至眼科。本综述概述了一种基于症状的系统性眼痛处理方法，以便神经科医生能够识别紧急情况、提高诊断效率并与眼科有效协作。
