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Der Ophthalmologe

, Volume 108, Issue 12, pp 1120–1126 | Cite as

Augenschmerzen aus neurologischer Sicht

  • O. Kastrup
  • H.-C. Diener
  • C. Gaul
Leitthema

Zusammenfassung

Viele Patienten mit neurologischen Störungen leiden an Kopf- oder Gesichtsschmerzen. Häufig ergeben sich klinisch Überlappungen mit differenzialdiagnostisch zu erwägenden ophthalmologischen Erkrankungen. Die Therapie chronischer Gesichts- und Kopfschmerzen sollte durch einen schmerztherapeutisch erfahrenen Neurologen erfolgen. Bei wiederkehrenden ins Auge projizierten Schmerzen handelt es sich häufig um Schmerzen, denen nicht unbedingt eine morphologische Schädigung an Auge oder Orbita zugrunde liegt. Symptomatische Kopf- und Gesichtsschmerzen können auch durch Gefäßprozesse im Kopf-Hals-Bereich ausgelöst werden. Aus diesem Grund ist eine differenzialdiagnostische Einordnung einer möglichen symptomatischen Schmerzursache unbedingt erforderlich. Ein vom Augenarzt morphologisch nicht erklärlicher Schmerz an Auge und Orbita sollte Anlass zu einer neurologischen Vorstellung geben. Bei episodischen Augenschmerzen kann der Neurologe anhand weiterer Symptomkonstellationen ggf. ein idiopathisches Kopf- oder Gesichtsschmerzsyndrom identifizieren und adäquat therapieren. Bei chronischen und persistenten Beschwerden sowie weiteren pathologischen körperlichen Befunden im neurologischen Untersuchungsbefund ist eine weitere bildgebende, elektrophysiologische oder liquorchemische Diagnostik erforderlich. Die Vielzahl von symptomatischen Augen- und Orbitaschmerzen, bedingt durch intrakranielle Pathologien, erfordert eine hohe differenzialdiagnostische Wachsamkeit.

Schlüsselwörter

Augenschmerz Neurologie Behandlung Kopfschmerzen Gesichtsschmerzen 

Facial and eye pain – Neurological differential diagnosis

Abstract

Head and facial pain are common in neurological practice and the pain often arises in the orbit or is referred into the eye. This is due to the autonomic innervation of the eye and orbit. There are acute and chronic pain syndromes. This review gives an overview of the differential diagnosis and treatment. Idiopathic headache syndromes, such as migraine and cluster headache are the most frequent and are often debilitating conditions. Trigemino-autonomic cephalalgias (SUNCT and SUNA) have to be taken into account, as well as trigeminal neuralgia. Trigemino-autonomic headache after eye operations can be puzzling and often responds well to triptans. Every new facial pain not fitting these categories must be considered symptomatic and a thorough investigation is mandatory including magnetic resonance imaging. Infiltrative and neoplastic conditions frequently lead to orbital pain. As a differential diagnosis Tolosa-Hunt syndrome and Raeder syndrome are inflammatory conditions sometimes mimicking neoplasms. Infections, such as herpes zoster ophthalmicus are extremely painful and require rapid therapy. It is important to consider carotid artery dissection as a cause for acute eye and neck pain in conjunction with Horner’s syndrome and bear in mind that vascular oculomotor palsy is often painful. All of the above named conditions should be diagnosed by a neurologist with special experience in pain syndromes and many require an interdisciplinary approach.

Keywords

Eye pain Neurology Treatment Headache Facial pain 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Neurologische Universitätsklinik EssenEssenDeutschland

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