Headache and eye pain

Advertise Your Event

Do you have an upcoming event that your would like to share with colleagues? We would love to hear from you!

Click on the “contact” button below, fill out the details in the pop-up and hit “submit”.

Subscribe to Resus

Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. And it's FREE!

  • We respect your privacy
  • This field is for validation purposes and should be left unchanged.

Register Now:

Sorry, we couldn't find any posts. Please try a different search.

Sorry, we couldn't find any posts. Please try a different search.

Recently at the EM Core we discussed headache and the red eye.

I had a great case just over a week ago. A patient was triaged with headache and cataract.

On examination he had a very painful right eye, which was causing the headache. He could only see outlines of my fingers…..He had been like this for one week.

Here is a picture of his eye. What do you think?

He had a ciliary flush(although not a huge one.

He had a cloudy cornea.

Visual acuity is decreased.

Pupil was not reactive.

On fluorescein staining, there was nothing to see.

He had ‘compartment syndrome of the eye’ – angle closure glaucoma.

The definitive diagnosis is made by taking pressures. This also differentiates it from keratitis.

Firstly we had trouble calibrating the ‘tono-pen’, then couldn’t measure a pressure with it. Then the penny dropped. I measured the pressure in the good eye and it was 11. The pen wasn’t measuring pressure as it was too high.

Next to treatment – acetazolamide 500mg IV, Timolol eye drops and alphagan eye drops, then transfer for definitive treatment under ophthalmology.

Posted in ,

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.


  1. Dr Talina Vizard on 12/09/2011 at 11:42 pm

    Great story great pictures. Thankyou

  2. Dr.Mohd.S.Jalal on 13/09/2011 at 6:35 am

    very important subject. Another point to be mentioned for management especially in the Rural setting where an ophthalmologist is not available, is how to do corneal indentation using a cotton stick as a last resort to decrease the IOP until ophthalmologist care is available.

  3. pat naidoo on 13/09/2011 at 10:36 pm

    great case and shows how the “headtie” differential can be used to make a diagnosis.

    Thanks again

  4. Dr Eva Wydymus on 13/09/2011 at 10:42 pm

    My first thought was Acute Glaucoma but the clouded cornea somewhat put me off. It looked like an ulcer from the distance. Thank God for Fluorescein.
    Good story. I like the twist with ‘tono-pen’.

  5. Michael Thomas on 15/09/2011 at 7:12 pm

    Love the triage diagnosis, ‘headache and cataract’.

    This is a spot diagnosis of acute glaucoma if I ever saw one.

    Would be funny to compile a sample of triage pearlers, for publication in a discrete place (ie on the internet), as I’ve seen some crackers over the past couple of years.

Leave a Comment