Photophobia of the eye

In blinding light, we shut our eyes, and their pupils involuntarily taper: this is how the reflex works, which protects the photosensitive receptors of the retina from "photon overexcitation". But painfully increased reaction - photophobia - is caused by light of usual intensity, which does not exceed either the average photosensitivity of the visual analyzer receptors, nor the level of natural adaptation of the eyes to brightness.

Photophobia (or photophobia) in ICD-10 is attributed to subjective visual disorders with the code - H53.1.

[1], [2], [3], [4], [5], [6]

Causes of eye photophobia

Considering the causes of eye photophobia, experts associate them with ophthalmic diseases, and with many others. What diseases cause photophobia?

Almost half of cases associated with ophthalmology are photophobia and conjunctivitis - acute bacterial, viral or allergic inflammation of the mucous membrane of the eye - as one of its main causes. Strong photophobia with hyperemia, lacrimation and itching is characteristic of allergic conjunctivitis, which occurs with hay fever; photophobia and pain in the eyes - part of the clinical picture of  epidemic hemorrhagic conjunctivitis.

When a foreign body enters the eye, irritating the  cornea, erosion of its superficial epithelium can result, causing severe pain in the eye and photophobia. In eye injuries with damage to the iris, ciliary body or retina, and also due to inflammation of the retina (retinitis), pain in the eyes, as well as redness of the eyes and photophobia, are felt.

In acute infectious or chronic keratitis (inflammation of the cornea), allergic and bacterial keratoconjunctivitis, with the defeat of the eyes of Herpes simplex virus with the development of  ophthalmic  herpes, patients complain of photophobia and lacrimation.

As one of the signs of eye disease, photophobia is noted:

• in cases of  infectious uveitis  (development of the inflammatory process in the uveal tract of the eye), with iridocyclitis (anterior uveitis) - inflammation of the iris and ciliary body of the choroid, and also if the vascular membrane and the retina of the eye become inflamed (and uveitis or chorioretinitis is diagnosed);
• with  dystrophy of the eye  (macular degeneration);
• when the intraocular pressure rises sharply in  glaucoma.

Lachrymation, "sand in the eyes" and photophobia - a characteristic manifestation  of red eye syndrome, and with xerophthalmia (dry eye syndrome) - photophobia and pain in the eyes.

Causes photophobia lack of vitamin B2 (riboflavin) - develops ariboflavinosis, as well as vitamin B3 (niacin) - with the development of pellagra.

As a postoperative effect caused by the laser keratomileusis (LASIK), patients have photophobia about a day after laser correction of vision.

There are symptoms of photophobia - in the form of reflex closure of the eyelids; increased lacrimation; redness of the eyes; burning, rubbing or pain in the eyes, the appearance of headaches - with  computer visual syndrome

[7], [8], [9], [10], [11]

Risk factors

The risk factors for the appearance of painful photosensitivity of the eyes are all the diseases and conditions listed in the ophthalmology. It should also take into account diseases that are not etiologically related directly to the eyes (see below).

Pathogenesis

Despite the prevalence of this symptom, in many cases the  pathogenesis of  its development remains unclear.

As noted in the Journal of Neuro-Ophthalmology, little has clarified the mechanism of painfully increased reaction to light of usual brightness of an attempt to detect abnormalities in the process of photoreception (in the work of ion channels on membranes of photosensitive cells) or to establish clear patterns in reducing the sensitivity limit of the retina in certain diseases.

Although among the ganglion cells (neurons) of the retina, which generate nerve impulses and through their axons transmit them to the brain, it was possible to detect especially photosensitive ganglia (IPRGC), directly reacting to light due to the presence of a pigment with increased photosensitivity (melanopsin). The results of the experiments showed that the activity of these neurons, when stimulated with light, is easily transmitted to the neurons of the trigeminal nerve, which causes an expansion of the eye vessels.

To date, understanding the pathogenetic features of disorders associated with photophobia is reduced to recognizing the main role of sympathetic innervation of the cornea, which determines its ultra-high sensitivity.

It is also recognized that the increased nervous excitability of the eye structures is additionally ensured by the absence of the myelin sheath on the ophthalmic branches of the trigeminal nerve (visual, ciliary, supraorbital, upper tear) extending into the cornea and on the axons of ganglion cells of the retina in the places where they pass through it to the posterior nerve pole of the eye, weaving into the optic nerve.

By the way, the optic nerves, through which the afferent impulses enter the visual zone of the cortex of the occipital lobes of the brain, like the olfactory ones, differ from other cranial nerves by their increased sensitivity, since they consist of a white brain substance.

We do not exclude the involvement in the pathogenesis of photophobia of impaired impulses either in the oculomotor nerve, or at the level of cholinergic synapses of preganglionic parasympathetic fibers, or else in the zone of receptive fields of bipolar retinal neurons.

More information in the article -  Conductive path of the visual analyzer

It is impossible not to mention the reflex mechanism of increased lacrimation, in most cases accompanying photophobia. By activating the production of tear fluid, the eyes are not only cleaned, but also protected from the development of infectious inflammation due to the lysozyme (hydrolase antibacterial enzyme) contained in it and lactoferrin (globular glycoprotein, which forms tissue immunity).

Photophobia as a symptom of a disease not related to ophthalmology

There is photophobia as a symptom of the disease when infecting deadly rabies virus (rabies virus), when botulinum neurotoxin enters the body and botulism develops, in tick-borne borreliosis (Lyme disease).

Usually hyperemia of the eyes, tearing of the eyes in the eyes and photophobia in the flu: viral virions fall not only on the nasopharyngeal mucosa, but also on the conjunctiva of the eyes.

For the same reason, almost always there are tearing and photophobia in ARVI or a runny nose and photophobia with colds, since there are also no "territorial" restrictions for airborne spreading of rhinoviruses.

Photophobia and temperature can be manifested not only with respiratory infections, but also due to inflammation of the brain (encephalitis) or its membranes (meningitis). A photophobia and headache appear in the squeaking of symptoms of subarachnoid hemorrhage with CCI or rupture of an aneurysm of the cerebral artery.

A lot of disorders in the work of the autonomic nervous system (sympathetic and parasympathetic) can cause photophobia in CVD - neurocirculatory dystonia or somatoform autonomic dysfunction, as well as during headache attacks with migraine and tension syndrome. With prolonged attacks, complaints of photophobia in the morning are noted; because of cerebrovascular disorders, the majority of patients with these neurological pathologies combine headache of different intensity, pressing sensations in the orbit, nausea and photophobia.

Close on the etiology of photophobia in neurosis - neurotic or somatoform disorder, developing for psychogenic reasons. That is, organic diseases are absent, and there is a psychosomatic photophobia - when hyperreaction to light is combined with general weakness and increased fatigue, dizziness, unstable blood pressure and episodic cardiac arrhythmia, sweating, nausea, etc.

Photophobia and pain in the eyes with lacrimation can be with thyrotoxicosis and diffuse toxic goiter. More information in the material -  Endocrine ophthalmopathy

And neurologists note various combinations of symptoms of photophobia in lesions of the branches and ganglia of the trigeminal nerve - the neuralgia of the nasociliary nerves or its ganglion (Charlene or Oppenheim syndrome), as well as the pterygoid ganglionitis (Slader's syndrome).

Photophobia in a child

In addition to the usual  acute conjunctivitis in children, in early childhood photophobia in a child is possible in the presence of hereditary pathologies: pigment xeroderma, ichthyosis, tyrosinemia of the second type (Richner-Hanhart syndrome), Chediak-Higashi syndrome. Read also -  Conjunctivitis in newborns  and  eye diseases in children

A feverish condition, papular-vesicular rash on the skin and photophobia in chicken pox are the result of inflammation of the skin and mucous membranes with lesions of herpesvirus Varicella zoster. Skin eruptions, eye pain, lacrimation and increased eye reaction to light are also noted when Rubella virus is infected with the development of measles rubella.

Rashes, very high fever and photophobia in measles, as well as other signs of this infectious disease are the result of infection of Measles morbillivirus (family Paramyxoviridae) and intoxication of the organism during the replication of its RNA. More detailed in the publication -  Lesion of eyes with chicken pox, measles, rubella

And in the development of epidemic enteroviral pemphigus (exanthema) in children - with severe headache and muscle pain, vomiting, fever, rash, inflammation of the conjunctiva and photophobia - the EUNO virus (Picornaviridae family) is to blame.

Photophobia with taking medication

First of all, increased sensitivity to light can be accompanied by a local application of ophthalmic drugs. For example, irritation and hyperemia of the conjunctiva, burning and painful sensations, tearing and photophobia from Corneregel (used for burns, erosion and inflammation of the cornea), from anti-herpetic drops of Idoxuridine and Trifluridin, and also Vidarabin gel.

Edema and redness of the eyelids, lacrimation, burning, pain in the eyes and photophobia from Restasis - eye drops containing the immunosuppressant cyclosporine and used in dry keratoconjunctivitis with reduced production of tear fluid - develop in one case of ten applications.

Immunosuppressive action has and prevents the rejection of transplants Tacrolimus (Advagraf, Prograf). Photophobia from Tacrolimus, along with more severe visual impairment, is on the list of its side effects.

Immunosuppressants include parenterally administered Humira (Adalimumab), used in the treatment of rheumatoid and psoriatic arthritis. Among the many side effects are allergic reactions, headache and photophobia from Humira.

Excess dose of analog preparations of thyroxin, which are prescribed for patients with hypothyroidism, thyroid hypertrophy or after its removal, may lead to the appearance of thyrotoxicosis. Therefore, photophobia is possible with an overdose of Eutirox (Levothyroxine, L-thyroxine, Eferox).

It should also be borne in mind that photophobia can provoke an overdose of retinol (vitamin A).

Photophobia in combination with other side effects can cause such drugs as: local anesthetic Lidocaine; blockers of m-holinoretseptorov (Atropine, Cyclomed, Ipratronium), spasmolytic Dicyclomine (Kombizpasm); Besalol tablets (due to the content of the belladonna extract); vasodilator blocker of α-adrenoreceptors Doxazosin (Cardura); quinolone antibiotic Norfloxacin; antitumor drugs-antimetabolites (Ftoruracil, Timazin, etc.).

Can increase intraocular pressure, disrupt accommodation and cause photophobia of the tranquilizer Buspirone (Spitomin). Side effects - redness of the eyes and photophobia - are noted after the application of iodine-containing radiopaque substances.

Diagnosis of photophobia

Diagnosis of the symptom, as expected, is conducted in the context of identifying the causes that cause it. Ophthalmologists must check the visual acuity of patients, examine the eyes with a slit lamp.

Instrumental diagnostics using ophthalmoscopy and tonometry is carried out. In more complex cases differential diagnostics with a wider hardware arsenal (X-ray, electroretinography, EEG, ultrasound of the eye orbit and periorbital area, MRI of the brain), the appointment of tests (for revealing the etiology of endocrine ophthalmopathy), surveys and consultations of specialized specialists come to the aid.

Also read -  Eye examination

[12], [13], [14]

Treatment of photophobia

If photophobia with flu, ARVI or chickenpox passes quickly - in many respects, due to the disinfecting properties of the abundantly allocated tear fluid, the treatment of photophobia separately from the eye diseases that cause it is impossible.

The main drugs in ophthalmology are eye drops, while special drops from photophobia, that is, from one, though polymorphic symptom, have not yet been synthesized. Therefore, treatment is prescribed depending on the diagnosed disease.

For example, eye drops Diclofenac (0.1%) are used to treat inflammation of the eyes (except herpesvirus) in adults.

3% eye drops Tobrex (Tebrix) and 0.3% Drops Floxal (Ofloxacin, Uniflox) contain antibiotics (respectively - tobramycin and ofloxacin) are effective in inflammatory processes in the cornea, conjunctiva, retina, uveal tract. In cases of bacterial, viral or fungal lesions of eye structures, doctors recommend ocomistin drops (with miramistin).

With allergic conjunctivitis or retinitis, you can apply Cromohexal (2% drop). A drop of Taurine is used as a restoring agent, acting on a cellular level on damaged tissues for injuries and dystrophy of the cornea and retina, with the erosion of the cornea and keratitis, eye lesions with herpes, etc.

See also -  Eye drops from conjunctivitis

With any etiology of photophobia, vitamins A, C and B should be present in the course of treatment.

Consequences and complications

Although photophobia has been officially identified as a subjective visual disorder, the negative consequences of this symptom can lead to complications of the disease and deterioration of both vision and general condition.

[15], [16], [17], [18]

Prevention

The recommendations on which prevention of eye diseases could take place differ little from the generally accepted provisions on hygiene, nutrition and work and rest: if work is related to eye strain, this is especially true, as is the requirement to limit the use of computer for children and adolescents and gadgets with small screens.

It is also useful to wear glasses from photophobia, which can serve as quality sunglasses.