Still in pain after hit in the eye

[SABrown72]

Three days ago, exactly, my 3 year old accidentally punched me right in the left eye (pushing the eyeball).  It was a substantial impact.  I'm still in pain - it basically feels like my eyeball aches and throbs (just a little throbbing).  I did see my ophthalmologist and my exam was totally normal.  

SO - is it normal for my eye to ache for this long after the incident, and what's the approximate timeline for when it will go away?  It was a little better yesterday but not better at all today.  Pain is about 4-5/10.

Thanks!

[JohnHaganMD]

I think you would need to discuss this additional finding (ENT) with your ophthalmologist.  It would be extremely rare for a cluster headache to start at exactly the same time your child hit you. There are also so called "facial pain (neuralgia) syndromes" the most well known and common is tic doulereaux (sp?) but again the timing is a stretch.    JCH MD

[SABrown72]

Thank you. I did ask the ENT but he said that he's not an ophthalmologist so couldn't really speak to the eye problem!  I read  that nasal lidocaine can help with cluster migraines, so I wonder if a similar mechanism is at play here.  Any advice about how to proceed?  Thank you!

[JohnHaganMD]

You should discuss this with the ENT but primary eye pain would not be relieved at all by numbing nostrils. However pain originating from the nostrils and secondarily projected to the eye would be, this is called 'referred pain".  This would tend to support the cause is not from the eye but from something in the naso-pharynx.  JCH MD

[SABrown72]

So, it's almost 9 days later, and I'm still in pain.  The pain is *slightly* better, but still present.  I saw an ENT today for sinus evaluation (unrelated), and he numbed both nostrils with lidocaine.  I experienced almost immediate relief of my eye pain, although it's back now, 4 hours later.  

Does the fact that the lidocaine eliminated the pain have any implications for why my eye is still hurting?  Thanks!

[JohnHaganMD]

Other than Tylenol or aspirin or ibuprofen not really

[SABrown72]

Thank you so much for your thoughtful reply. If it is a bruised nerve, are there any medications I can take for the pain that would be effective?  Thanks!

[JohnHaganMD]

Yes, if some of the force was transmitted to the lids it's possible for the sensory nerves of the eyelid and face (trigeminal nerve) to be contused against the orbital bones creating the type of pain you describe.  This is pretty common with injuries like hit by fist in fight, blows to the eye from athletic equipment, falls and running into things.  It clears with time you might think of it as a bruised nerve. But some of the force would have had to be delivered to the eyelids, forehead or cheek.  These rarely require anything other than patience and time.   JCH MD

[SABrown72]

Thank you for your reply!  It's definitely not a corneal abrasion (for now) - she was very careful and checked and said that my cornea looked totally normal.  

The pain doesn't feel like it's on the surface of my eye; feels like a deeper pain, like in the socket.  Could there be nerve or muscle damage? Thank you!

[JohnHaganMD]

If your eye exam was completely normal other causes could be something else was injured.  That is orbital or sinus damage. Hard to imagine a 3 year old could do that but its possible. If your pain persists or worsens, or new symptoms appear I would return to see the ophthalmologist.  By far the most common painful condition with this type of injury is a corneal abrasion. Even a small one can be painful.   JCH MD