A retrospective chart review on the causes of photophobia was published in the Journal of Neuro-Ophthalmology. The research team evaluated 147 patients (111 adults, 36 children) who presented to an ophthalmology clinic with a primary complaint of photophobia.
What did they find?
The most frequent cause of photophobia was migraine headache (53.7%), followed by dry eye syndrome (36.1%), ocular trauma (8.2%), progressive supranuclear palsy (6.8%), and traumatic brain injury (4.1%).
What else came out of this study?
The authors discovered that a significant number of patients (25.9%), especially children, left the clinic without any diagnosis or treatment for their photophobia (11.7% of adults and 69.4% of children).
This observation indicates that eye care providers, especially those caring for children, may not know the most common causes of photophobia and, therefore, may not know what patient history questions to ask and what examination techniques to use to identify such causes.
What were some helpful questions to ask children?
Previous studies have found that migraines are underdiagnosed and misdiagnosed in children, so asking these patients or their families about headaches, carsickness, unexplained abdominal pain, and a family history of migraine or headache may point the clinician toward this diagnosis.
Other less common differentials for photophobia in children include benign essential blepharospasm, congenital glaucoma, cone dystrophy, and uveitis.
The take home:
This study highlights that photophobia affects patients of all ages, and many are left without a specific diagnosis, indicating a significant knowledge gap among ophthalmologists and optometrists evaluating these patients.
The authors of the study are working to address this knowledge gap by developing a curriculum to teach eye care providers how to approach patients with photophobia in the presence of a normal eye examination.