Eye Pain

[George511]

I have Exophthalmos from Graves Disease.  I have been having eye pain, sometimes severe.  An MRI was done and there is extra-occular muscle enlargement which was determined to be associated with the Graves but I was told it did not appear to be severe enough to be causing the severe pain (pressure around the optic nerve at the annulus of Zinn).  When you have extra-occular muscle enlargement can the extraocular muscle swelling VARY throught the day causing pain.  My pain increases with eye strain throughout the day and in the evening.  It is also bad when I wake up in the morning.  It takes a while after putting on my glasses for my eyes to focus and it is painful.  It has been bad enough to knock me to my knees.  When it gets that bad I cannot keep my eyes open.  Opening the eyes and trying to focus causes this severe pain.  

[John C Hagan III, MD, FACS, FAAO]

It would be a second opinion because it sounds like neither you nor your present ophthalmologist have a good explanation for the severe pain.

JCH MD

[George511]

My ophthalmologist already did a complete exam, measuring eye pressure, protrusion, etc.  I also had a vision exam and my prescription for reading distance has changed by 30% which is causing eye strain.  I will be getting new glasses.  The MRI was completed to ensure there wasn't substantial swelling/enlargement of the extraocular muscles that could have been putting pressure on the optic nerve.  This kind of swelling is common with Graves/Exophthalmo.  The tests didn't show any substantial muscle enlargement that would cause the severe pain according to the doctor.  What would an orbital-oculoplastic surgeon or neuroophthalmologist see from the MRI that my doctor wouldn't have seen?

[John C Hagan III, MD, FACS, FAAO]

Severe pain is unusual with Graves. I would suggest you ask your present ophthalmologist for a second opinion either from an orbital-oculoplastic surgeon or a neuroophthalmologist.

JCHMD