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A 57-year-old woman with periocular pain
Digital Journal of Ophthalmology 2021
Volume 27, Number 3
September 3, 2021
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Bryan Strelow, MD, MA | Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Michelle Nguyen, BS | School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Meredith R. Klifto, MD | Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Differential Diagnosis
The initial presentation of periocular pain and elevated IOP was suggestive of angle closure. The nonophthalmic differential diagnosis for angle closure symptoms includes trigeminal neuralgia, migraine and other headache syndromes, and temporal arteritis. Due to the continued headaches and stable IOPs and examination, primary angle closure syndrome was thought to be less likely related to her symptoms. As part of a systemic work-up, complex migraine syndrome, trigeminal neuralgia, parotiditis, temporomandibular joint dysfunction, and spontaneous intracranial hypotension were considered, and various diagnostic testing and therapeutic trials were attempted.
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