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The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics

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The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2018 The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics Bowen, Randy C ; Koeppel, Jan N ; Christensen, Chance D ; Snow, Karisa B ; Ma, Junjie ; Katz, Bradley J ; Krauss, Howard R ; Landau, Klara ; Warner, Judith E A ; Crum, Alison V ; Straumann, Dominik ; Digre, Kathleen B Abstract: BACKGROUND Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most com- mon causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. METHODS This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzer- land, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint. RESULTS Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients). CONCLUSIONS Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties. DOI: https://doi.org/10.1097/WNO.0000000000000601 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-157077 Journal Article Published Version Originally published at: Bowen, Randy C; Koeppel, Jan N; Christensen, Chance D; Snow, Karisa B; Ma, Junjie; Katz, Bradley J; Krauss, Howard R; Landau, Klara; Warner, Judith E A; Crum, Alison V; Straumann, Dominik; Digre, Kathleen B (2018). The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics. Journal of Neuro-Ophthalmology, 38(3):320-327. DOI: https://doi.org/10.1097/WNO.0000000000000601 Original Contribution The Most Common Causes of Eye Pain at 2 Tertiary Ophthalmology and Neurology Clinics Randy C. Bowen, MD, MS, Jan N. Koeppel, MD, Chance D. Christensen, BS, Karisa B. Snow, PharmD, Junjie Ma, MS, Bradley J. Katz, MD, PhD, Howard R. Krauss, MD, Klara Landau, MD, Judith E. A. Warner, MD, Alison V. Crum, MD, Dominik Straumann, MD, Kathleen B. Digre, MD Background: Eye pain is a common complaint, but no a neurology clinic. Inflammatory eye disease (conjunctivitis, previous studies have determined the most common causes blepharitis, keratitis, uveitis, dry eye, chalazion, and scler- of this presenting symptom. Our objective was to determine itis) was the underlying cause of eye pain in 1,801 (69.1%) the most common causes of eye pain in 2 ophthalmology and of all patients analyzed. Although only 71 (3%) of 2,407 neurology departments at academic medical centers. patients had migraine diagnosed in an ophthalmology clinic Methods: This was a retrospective cross-sectional analysis as the cause of eye pain, migraine was the predominant and chart review at the departments of ophthalmology and cause of eye pain in the neurology clinics (100/196; 51%). neurology at the University Hospital Zurich (USZ), University Other causes of eye pain in the neurology clinics included of Zürich, Switzerland, and the University of Utah (UU), USA. optic neuritis (44 patients), trigeminal neuralgia, and other Data were analyzed from January 2012 to December 2013. cranial nerve disorders (8 patients). We included patients aged 18 years or older presenting with Conclusions: Eye pain may be associated with a number of eye pain as a major complaint. different causes, some benign and others sight- or life- Results: Two thousand six hundred three patient charts met threatening. Because patients with eye pain may present to inclusion criteria; 742 were included from USZ and 1,861 either a neurology or an ophthalmology clinic and because the were included from UU. Of these, 2,407 had been seen in causes of eye pain may be primarily ophthalmic or neurologic, an ophthalmology clinic and 196 had been seen in the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties. Department of Ophthalmology and Visual Sciences (RCB, CC, KBS, BJK, Journal of Neuro-Ophthalmology 2018;38:320–327 JEAW, AVC, KBD), John A Moran Eye Center, Salt Lake City, Utah; doi: 10.1097/WNO.0000000000000601 Department of Neurology (RCB, CC, KBS, BJK, JEAW, AVC, KBD), © 2017 by North American Neuro-Ophthalmology Society University of Utah Health Sciences Center, Salt Lake City, Utah; Depart- ments of Ophthalmology and Neurology(JK,KL,DS),UniversityHospital Zurich, University of Zurich, Zurich, Switzerland; Department of Oph- thalmology and Neurosurgery (HK), University of California at Los An- ye pain is a common complaint in ophthalmology and geles, Los Angeles, California; and Department of Pharmacotherapy (JM), also can be a complaint in neurology. No previous studies College of Pharmacy, University of Utah, Salt Lake City, Utah. E have determined the most common causes of this presenting This investigation was supported by an unrestricted grant from Research to Prevent Blindness, Inc., New York, NY, to the Depart- symptom. Our objective was to determine the most common ment of Ophthalmology & Visual Sciences, University of Utah. causes of eye pain in 2 tertiary ophthalmology and neurology Presented at the Annual Meeting of the North American Neuro- departments. We then wished to know how the most common Ophthalmology Society, March 1, 2016, Tucson, AZ; Annual Scientific causes of eye pain differed at the 2 institutions and how these Meeting of the American Headache Society, June 11, 2016, San Diego, CA. causes differed between departments of ophthalmology and The authors report no conflicts of interest. neurology. We also wanted to know if the laterality or character Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the full text of the pain was associated with particular causes of eye pain. and PDF versions of this article on the journal’s Web site (www. jneuro-ophthalmology.com). METHODS R. C. Bowen and J. Koeppel contributed equally to the manuscript and should both be recognized as first authors. Address correspondence to Kathleen B. Digre, MD, Johan A Moran Study Design and Objective Eye Center, University of Utah Health Sciences Center, 65 N Mario Capecchi Drive, Salt Lake City, UT 84132; E-mail: Kathleen.digre@ A retrospective cross-sectional analysis was performed at the hsc.utah.edu University of Utah (UU), USA and at the University 320 Bowen et al: J Neuro-Ophthalmol 2018; 38: 320-327 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Original Contribution Hospital Zurich (USZ), Switzerland for all patients who Patient charts containing at least one highlighted search presented to these tertiary ophthalmology and neurology term were reviewed for inclusion criteria. We performed departments with a primary complaint of eye pain in the a second query in the UU data storage warehouse to access history of present illness. The primary outcome was the all patient charts with chief complaints of eye pain, eye pain diagnosed cause of eye pain. Secondary outcomes included no injury, eye itching/irritation, eye irritation, eye burn, and laterality of the pain, characteristics of the pain (e.g., burning eyes. Each patient chart underwent review for burning pain, stabbing pain, pain with eye movement), inclusion criteria. Data were collected using Excel 2013 patient demographics, and whether the patient presented to (Microsoft, Redmond, WA). a neurology or an ophthalmology clinic for evaluation. Statistical Analysis fi Identi cation and Eligibility of Patients Chi-square (x2) tests were used (statistical significance set at Institutional review board approval was obtained for both P , 0.05) to compare primary outcomes between institu- institutions. Because this investigation was a retrospective tions, departments, ages, gender, laterality, and pain char- chart review and because no protected health information acteristics. Patients who did not have a descriptive pain was collected, informed consent was waived. The elec- characteristic other than “eye pain” were excluded from tronic medical records (EMRs) were reviewed for all the pain characteristics analysis. Age was categorized into patients aged 18 years and older with a major complaint 4 groups for statistical analyses (18–34, 35–54, 55–64, and
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