A 57-year-old woman with periocular pain

Abstract

A 57-year-old white woman presented to the outpatient glaucoma clinic of the University of North Carolina Health System for a scheduled appointment with a new complaint of worsening headache in the setting of recent sinus infection of 3 weeks’ duration. She had been referred to the glaucoma clinic for mildly elevated intraocular pressure (IOP) as a known primary angle-closure glaucoma suspect (both eyes) after bilateral laser peripheral iridotomy (LPI). She had a maternal family history of glaucoma. She denied history of other prior eye disease or surgery, and she denied history of prior eye trauma. Her past medical history was significant for chronic pain, including lumbar radiculopathy, myofascial pain syndrome, and migraine headaches, for which she was followed by pain management specialists.

Further history revealed that 6 years earlier, the patient was referred by optometry to an outside glaucoma specialist for concerns of angle closure in the setting of narrow angles. She reported symptoms of periocular headache and photophobia. At that time, records indicated that she had narrow, occludable angles in both eyes with closed presentation on gonioscopy and normal IOPs of 16 mm Hg in each eye. Prophylactic LPI was recommended and performed at that time.