Phot ophobia and ocular pain associated with possible higher brain dysfunction

Abstract

Aim: To obtain more information concerning patients with persistent difficulty in using vision despite pathology in neither eyeballs nor optic pathway. Methods: From November 2018 to April 2019, our working group (WG) consisting of experts of neuro-ophthalmology and/or low vision gathered such patients exhibiting visual distubance cases of blepharospasm, psychogenic visual loss, and malingering were excluded. The WG further decided on the following secondary exclusion criteria, to present cases with common clinical characteristics: 1) cases of diseases identified by head MR, 2) confirmed cases of either vision impairment influenced by psychiatric disorders or the converse, and 3) cases with visual difficulty du to disturbance in eye movements and/or eye position. Results: There were 33 cases in all (age range: 16-80 years, male to female ratio: 9:24). Clinical characteristics showed visuosensory disturbance, including 26 patients with non-ocular photophobia, 5 patients with ocular or periocular pain, 21 patients with both, and 1 patient with neither. In most cases, these symptoms were exacerbated both by visual intention and by the process of seeing/watching something. In more than 3 cases, coexisting clinical conditions such as cerebrospinal fluid hypovolemia, migraine, continuous usage of benzodiazepines, and fibromyalgia were observed. Conclusions: Most of the cases had disturbed daily vision due to either persistent photophobia or ocular pain without any underlying causes in the eyeballs and optic pathway. These cases with visuosensory hypersensitivity probably have higher brain dysfunction related to vision, but the detailed mechanism is still unknown.