Pain at back of eye socket: 7 Reasons Why There’s Pain Behind Your Eye


7 Reasons Why There’s Pain Behind Your Eye

At one time or another, each of us has likely experienced some type of eye pain. It can range from dull to intense and can be sometimes be accompanied by fever, tearing, redness, light sensitivity, sinus pressure, double vision, and numbness. Most often, pain behind your eye isn’t a serious condition, but in some instances, it can be. That’s why it’s important to figure out what’s most likely causing your eye pain. Here are some common reasons associated with pain behind your eye.

  1. Dry eye. Dry eye syndrome is a relatively common condition in which your eyes are unable to produce adequate tears to moisten the eye. Dry eyes can bring on sensitivity to light and headaches, both of which can be painful and lead to pain behind your eyes.
  2. Problems with vision. If you have a tendency to focus or squint to make up for a vision problem like farsightedness, nearsightedness, or astigmatism, you are more prone to develop eye pain. That’s because your brain and eyes are trying to compensate for your compromised vision.
  3. Sinus inflammation. Also referred to as sinusitis, sinus inflammation causes pressure and pain behind your eyes and tenderness in the front of your face.
  4. Throbbing pain from a migraine headache almost always includes pain behind the eyes.
  5. This condition is caused by the buildup of intraocular pressure. And when pressure increases in your eye, it can lead to pain oftentimes coupled with nausea, swollen eyelids, watery eyes, and loss of peripheral vision.
  6. When pain is felt specifically behind the left eye, it could possibly indicate a brain aneurysm. This occurs when blood vessels or an artery wall in the brain are weak, resulting in possible hemorrhaging or stroke.
  7. Stabbing pain behind the eye could be caused by inflammation from inside the sclera (the outer coating of your eye ball.) This condition is sometimes combined with other symptoms like redness and light sensitivity.

If you’re experiencing moderate to severe eye pain, or to learn more about any of the services we provide, please call North Toronto Eye Specialists today to schedule an appointment with one of our doctors at 416-748-2020.


Acute sinusitis

Sinusitis is inflammation of the linings of the sinuses that surround the nose. Common symptoms include a tender face and a blocked nose. It’s often caused by an infection.

About sinusitis

What are sinuses?

The sinuses are air-filled spaces behind the bones of your face that open up into the nose cavity. They are lined with the same membrane as your nose. This is called the mucous membrane and it produces a slimy secretion called mucus to keep the nasal passageways moist and to trap dirt particles and bacteria.

You have four main sets of sinuses.

  • The maxillary sinuses are in each cheekbone
  • The frontal sinuses are on either side of your forehead, above your eyes
  • The smaller ethmoid sinuses are behind the bridge of your nose, between your eyes
  • The sphenoid sinuses are between the upper part of your nose and behind your eyes

The maxillary sinuses are the largest of the sinuses and the ones most commonly affected by sinusitis.

What is sinusitis?

Sinusitis is inflammation of the mucous membranes of one or more of your sinuses.

If your sinusitis lasts anything from a few days up to a month it’s called acute sinusitis. If your sinusitis is an ongoing problem lasting three months or more you may have chronic sinusitis (see Related topics). The medical terms acute and chronic refer to how long the condition lasts for, rather than how severe it is.

Acute sinusitis is common and can affect people of any age.


If you have sinusitis you may feel generally unwell and have a blocked nose. Sometimes people think they have a common cold when they have sinusitis. If you have sinusitis, your symptoms may include:

  • pain and pressure in your face, which is worse when you lean forwards
  • a blocked nose with green or yellow mucus, which can drain down the back of your nose into your throat and may cause a sore throat and cough
  • a headache when you wake in the morning
  • a fever
  • earache
  • toothache or pain in your upper jaw

The pain you have will depend on which of your sinuses are affected.

  • Frontal sinusitis can cause pain just above your eyebrows, and your forehead may be tender to touch.
  • Maxillary sinusitis can cause your upper jaw, teeth and cheeks to ache and may be mistaken for toothache.
  • Ethmoid sinusitis can cause pain around your eyes and the sides of your nose.
  • Sphenoid sinusitis can cause pain around your eyes, at the top of your head or in your temples. You may also have earache and neck pain.

On very rare occasions, a sinus infection can spread to the bones of the face or the membranes lining the brain. Also very rarely, sinusitis can spread to form a pocket of pus (abscess) in the eye socket, the brain or a facial bone. If you develop swollen eyelids while you have sinusitis you should see your GP immediately.


Acute sinusitis is caused by an infection of the mucous membranes with a virus, bacterium or fungus. Most people with sinusitis have a viral infection such as the common cold.

The mucus that is produced by the mucous membranes in your sinuses normally drains into your nose through small holes called ostia. The ostia can become narrow or even blocked if the sinuses get infected and inflamed so the mucus cannot drain properly.

This can also happen if your membranes are irritated by something. Examples of irritants include:

  • airborne allergens such as grass and tree pollen
  • smoke and air pollution
  • sprays containing chemicals (eg household detergents)
  • nasal decongestants, if overused
  • chronic drug misuse (snorting substances such as cocaine)


Your GP will ask you about your symptoms and will examine you. He or she may also ask you about your previous illnesses and operations.

Your GP will usually be able to diagnose your sinusitis just from examining you and no further medical tests are usually necessary.


Most people with acute sinusitis get better without treatment. However, you may find that home treatments and over-the-counter medicines provide some relief.

Some people find that breathing in steam from a bowl of hot (but not boiling) water containing a few drops of menthol oil (eg Olbas oil or Karvol) provides some relief from the symptoms. However, this isn’t scientifically proven. Another method is to sit in the bathroom with the hot shower running and inhale steam this way. Some people find that applying a warm compress on the areas of the face that are painful and sleeping with their head and shoulders propped up with pillows provides relief but again there is no scientific evidence that this works.

You can take the painkiller you usually take for a headache to relieve pain and lower your temperature if you have a fever.

Decongestant tablets, such as pseudoephedrine (eg Sudafed), may reduce swelling in your nose and allow your sinuses to drain. Decongestant nasal sprays are also available but you should not use them for more than a week, as prolonged use can actually make nasal blockage worse in the long run. Always read the patient information leaflet that comes with your medicine and ask your pharmacist or doctor for advice.

If your symptoms continue for more than a week you may wish to see your GP. If the sinusitis is thought to have been caused by a bacterial infection, your GP may prescribe antibiotics.


There are a number of things you can do to help prevent sinusitis developing such as:

  • taking a short course (usually no longer than seven days) of decongestant medicine when you have a cold
  • having a flu vaccination each year
  • staying well hydrated by drinking plenty of fluids
  • not smoking
  • staying away from smoky environments
  • keeping your allergy symptoms under control – ask your doctor or pharmacist for advice
  • maintaining good general health by eating healthily and taking regular exercise

Further information

The British Association of Otorhinolaryngologists (ENT-UK)


  • About Sinusitis. ENT-UK. www.entuk.org, accessed 24 May 2007
  • Patient information rhino sinusitis in children. ENT-UK. www.entuk.org, accessed 24 May 2007
  • Sinusitis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 23 May 2007
  • Ah-See K, Evans AS. Sinusitis and its management. BMJ 2007; 334:358-361
  • Collier J, Longmore M, Scally, P. Oxford Handbook of Clinical Specialities. 6th ed. Oxford: Oxford University Press, 2003
  • Sinusitis. National Institute of Allergy and Infectious Diseases, National Institute of Health, US department of health and human services. www.niaid.nih.gov, accessed 23 May 2007
  • Scottish Advisory Committee on Drug Misuse: Psychostimulant Working Group Report. Scottish Executive, Substance Misuse Division, 2002. www.scotland.gov.uk, accessed 5 June 2007
  • British Medical Association. British National Formulary 53 March 2007. London: BMJ Publishing Group Ltd, RPS Publishing, 2007


Related topics

Chronic sinusitis

Sinusitis in children

Eye Pain | 10 Causes & When to Worry

Causes of eye pain

The eye consists of several parts, each of which can be affected by painful problems such as irritation, injury, or infection.

Eye anatomy

It is helpful to know the parts of the eye where the most common problems occur:

  • Cornea: This is a thin and very sensitive protective layer that covers the central part of the eyeball including the pupil and iris — the colored area of the eye.
  • Conjunctiva: This protective layer lines the white part of the eyeball (called the sclera) as well as the inner surface of the eyelids.

While irritation to the surface of the eye is most common, eye pain symptoms may also be the result of deeper problems like increased pressure on the eyeball, migraines, or certain nerve issues.

Surface eye pain problems

Pain felt on the surface of the eye may be related to the following.

  • Allergies: Common allergies like hay fever will lead to itchy and scratchy eyes that may also become very red.
  • Dry eye: The eye depends on natural lubricating tears to stay healthy, and without them, it is vulnerable to irritation and injury. Some people simply do not produce enough tears, while certain activities like staring at a computer screen can also lead to dryness.
  • Abrasion: A scratch on the cornea from contact lenses or injury is known to be extremely painful.
  • Infection: Viruses and bacteria can invade the surface of the eye, especially the conjunctiva, and cause pain, redness, and swelling.
  • Foreign body: Anything from an eyelash to a piece of glass can lead to painful eye injuries.
  • Chemical burn: Common household items like cleaning fluid can be dangerous to the eye.
  • Contact lenses: Contacts can be harmful if not removed and cleaned regularly.

Other eye pain problems

Other causes of eye pain may be related to the following.

  • Eyestrain: Struggling to see without correctly prescribed glasses or contacts can be uncomfortable, especially for prolonged periods or in dim light.
  • Increased pressure: Abnormally high pressure behind the eye in conditions like glaucoma can be painful if not properly managed.
  • Headaches and migraines: Pain from these conditions can center around or stem from behind the eye.
  • Nerve pain: The nerve connecting the eye to the brain can become inflamed in certain conditions like multiple sclerosis.
  • Swelling: Some medications may cause dangerous and uncomfortable swelling around the eyes called angioedema.

This list does not constitute medical advice and may not accurately represent what you have.

Foreign body in the eye

Foreign bodies like windblown grit, wood or masonry, or flecks of metal can land in the eye and get stuck there, causing extreme discomfort.

Rarity: Uncommon

Top Symptoms: feeling of something in the eye

Symptoms that always occur with foreign body in the eye: feeling of something in the eye

Urgency: In-person visit

Bacterial conjunctivitis

Bacterial conjunctivitis, or pinkeye, is an inflammation of the clear membranes covering the eye. It causes redness, pain, and irritation of one or both eyes.

Staphylococcus or streptococcus bacteria are often involved, and anything that brings bacteria to the eye can cause conjunctivitis. Touching the eyes with unwashed hands; sharing eye makeup, washcloths, or towels; or improperly cleaning contact lenses are common causes. The same bacteria that cause the sexually transmitted diseases chlamydia and gonorrhea can also cause conjunctivitis.

Most susceptible are children, but anyone can be affected.

Symptoms include a gritty, burning feeling in the eye; discharge or tears; swelling; itching; pink discoloration due to dilated blood vessels; and sensitivity to light.

Diagnosis is made through patient history, physical examination, and careful eye examination. Smears may be taken from the eye for testing.

Treatment involves a course of antibiotic eyedrops. It is important to use all of the drops as prescribed, even when the infection seems to improve. Warm compresses over the eyes can help ease the discomfort.

Rarity: Common

Top Symptoms: sore throat, eye redness, eye itch, watery eye discharge, eye redness

Symptoms that always occur with bacterial conjunctivitis: eye redness

Urgency: Primary care doctor

Vernal conjunctivitis

Vernal conjunctivitis is long-term (chronic) swelling (inflammation) of the outer lining of the eyes due to an allergic reaction. Vernal conjunctivitis often occurs in people with a strong family history of allergies, such as allergic rhinitis, asthma, and eczema.

Rarity: Ultra rare

Top Symptoms: wateriness in both eyes, eye itch, eye redness, sensitivity to light, feeling of something in the eye

Urgency: Primary care doctor

Corneal abrasion

Corneal abrasion is a wound to the part of the eye known as the cornea. The cornea is the crystal clear (transparent) tissue that covers the front of the eye. It works with the lens of the eye to focus images on the retina.

Rarity: Common

Top Symptoms: blurry vision, sensitivity to light, constant eye pain, moderate eye pain, pain in one eye

Symptoms that always occur with corneal abrasion: pain in one eye, wateriness in one eye, constant eye pain

Urgency: Phone call or in-person visit

Inflamed eyelid (blepharitis)

Inflamed eyelid, or blepharitis, is a bacterial infection of the skin at the base of the eyelashes.

If the oil glands around the eyelashes become clogged, normal skin bacteria will multiply in the oil and cause infection. The glands can become blocked due to dandruff of the scalp and eyebrows; allergies to eye makeup or contact lens solution; or eyelash mites or lice.

Symptoms include red, swollen, painful eyelids; oily, dandruff-like flakes of skin at the base of the eyelashes; and eyelashes that grow abnormally or fall out.

If the symptoms do not clear with hygiene, see a medical provider. Blepharitis can become chronic and lead to infections of the eyelids and cornea; dry eyes which cannot take contact lenses; and scarring and deformity of the eyelids.

Diagnosis is made through physical examination of the eyelids, under magnification and through skin swab of the eyelashes.

Treatment includes warm compresses and careful washing of the eyelids; antibiotics in pill or cream form; steroid eyedrops; and treatment for any underlying condition such as dandruff or rosacea.

Rarity: Common

Top Symptoms: eye itch, sensitivity to light, eye redness, feeling of something in the eye, dry eyes

Symptoms that never occur with inflamed eyelid (blepharitis): severe eye pain

Urgency: Self-treatment

Chronically dry eyes

Chronically dry eyes are a relatively common condition, especially in older adults, that can be very uncomfortable and lead to damage of the surface of the eye. They are caused by a decrease in the tear production of the eye or an increase in tear evaporation. Risk factors inc..

Contact lens-related eye infection

Millions of people wear contact lens daily without issue; however, there is a risk of infection. Often, infection is avoidable by keeping lenses clean.

Rarity: Rare

Top Symptoms: eye redness, wateriness in both eyes, sensitivity to light, constant eye redness, eye redness

Symptoms that always occur with contact lens-related eye infection: eye redness, constant eye redness

Urgency: In-person visit

Acute close-angle glaucoma

Acute closed-angle glaucoma is also called angle-closure glaucoma or narrow-angle glaucoma. “Acute” means it begins suddenly and without warning.

“Glaucoma” means the fluid pressure inside one or both eyes is too high. “Closed-angle” means that the iris – the circular band of color in the eye – does not dilate open properly and blocks the natural drainage mechanism within the eye. The fluid builds up and causes the pressure to increase.

The exact cause of any glaucoma is not known. It may be an inherited trait.

Acute closed-angle glaucoma can be triggered by an extreme dilation of the eyes, as when walking from bright light into total darkness.

Symptoms include sudden eye pain, headache, nausea, blurred vision, and seeing a rainbow-like aura around lights. This is a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history and thorough eye examination.

Treatment involves surgery to correct the dilation and drainage mechanisms of the eyes, as well as prescription eyedrops and oral medications.

Rarity: Rare

Top Symptoms: headache, nausea or vomiting, vision changes, being severely ill, eye pain

Urgency: Hospital emergency room

Anterior uveitis

Uveitis refers to any inflammatory condition that causes swelling and destroys the tissues of the middle layer of the eye. It can occur in people of all ages, but primarily affects people between the ages of 20 and 60 years old.

Uveitis may be the result of eye problems or diseases, or i..

Orbital cellulitis

Orbital Cellulitis is an uncommon condition in which an infection has breached or circumvented the outer portion of the eye and affected the tissues of the orbit, also known a..

Migraine Headache vs. Headache: Yes That Pain Behind Your Left Eye Matters | Cove

Your world grinds to a halt as a throbbing pain behind your left eye spreads, expanding until you swear you can feel your teeth pulsing. The light from your phone causes an explosion of pain, and every sound feels like an ice pick to your temple. You prepare to hide in your bedroom for the next several hours, and then your friend says it: “Why don’t you have some water? It’s just a headache, right?”

Maybe you’re not sure what’s causing the pain—it could be a migraine attack, a sinus headache, or something else entirely. What you do know? It’s much more than “just a headache.”

But to make it go away, you need to know what you’re dealing with. So, what exactly distinguishes a migraine from other types of headaches?

It might seem obvious, but we know that most headaches and headache disorders cause head pain—the type of head pain and the accompanying symptoms differ based on what kind of headache you have.

Before we cover some of the many types of headaches out there, let’s talk about what a migraine is. The most well-known migraine symptom is a pounding, severe headache, usually starting on just one side of your head. But migraine symptoms typically follow a unique pattern, too.

The scientific term for the period before the headache sets in is the “prodrome. ” It can last for a few hours, or even up to a few days. During this period, it’s common to experience symptoms like:

  • difficulty concentrating, speaking, or reading

  • food cravings

  • frequent yawning

  • increased urination

  • nausea, constipation, or diarrhea

  • sensitivity to light, sound, touch, and smell

  • stiff muscles

  • trouble sleeping

Some migraine sufferers also have an aura within the hour before their headache. The aura can include:

  • visual disturbances, like flashing lights, blind spots, geometric shapes, etc.

  • sensory disturbances, like numbness, pins and needles sensations, etc.

  • brainstem-related symptoms, such as vertigo, difficulty speaking, ringing ears, etc. (Note: This is rare.)

  • retinal symptoms, usually temporary partial or total blindness in just one eye. (Note: This is rare.)

Once the headache strikes, the migraine pain can last 4-72 hours, and be debilitating.

Afterward, many people will be stuck recovering from a “migraine hangover,” or, to get scientific, a “postdrome.” The hangover can last several days and leave you nauseous, moody, thirsty or craving certain foods, unable to concentrate, and sensitive to lights and sounds.

You’ll need to talk to a doctor to get migraine treatment, though some home remedies can help soothe your migraine symptoms or treat your migraine triggers.

In contrast, many of the headaches we’ll discuss below can be treated with over-the-counter anti-inflammatories, pain relievers, and lifestyle changes. With that said, while not every headache is a migraine, many headaches can still be extremely painful.

Let’s take a look…

It’s hard to say how many types of headaches there are because they’re often symptoms of other conditions. In that vein, we can divide types of headaches into two categories: primary and secondary.

Primary headaches are not caused by other underlying conditions or illnesses, according to Mayo Clinic, but by overactivity or chemical changes in the brain, the nerves, blood vessels, or muscles in or around your head. Secondary headaches, on the other hand, result from other issues, like viral or bacterial infections, injuries or traumas, and dehydration, to name a few.

In other words, secondary headaches are a side effect of another condition, while primary headaches are the condition.

Migraines are considered primary headaches, along with the following headaches listed in IDHC-3, the International Headache Society’s officially recognized list of headaches:

Tension headaches typically come on slowly and involve mild or moderate (but not severe) pain that feels like a vice or band wrapping around your head. Unlike a migraine, tension headaches usually hurt on both sides of your head, and don’t bring along telltale migraine symptoms like nausea, sensitivity to light, aura, or the prodrome stage.

Tension headaches can be caused by a variety of triggers, according to Medline Plus, such as:

  • alcohol and caffeine

  • clenching or grinding your teeth

  • holding your head in one position for too long

  • sleeping in a strange position or in a cold room

  • straining your eyes

  • stress

You can often treat a tension headache with over-the-counter pain relievers, as well as preventive treatments like acupuncture, meditation, and cognitive behavioral therapy.

According to the Genetic and Rare Disease Information Center (GARD), cluster headaches are extremely painful, marked by severe pain that gets worse over a period of 5-10 minutes, and lasts for up to three hours. They pop up in bursts (or clusters), and you can get them up to eight times a day for weeks at a time (usually 6-12 weeks). They can bring along other issues, like facial swelling or drooping, nasal dripping, and other symptoms at or near the site of the pain, reports GARD.

What causes cluster headaches? Scientists aren’t sure. But, according to Mayo Clinic, they might have to do with your body’s sleep clock. Men, smokers, and alcohol users are more likely to get cluster headaches, but they can also be genetic.

Besides these two common kinds of non-migraine headaches, the ICHD-3 lists several other types of primary headaches:

Cough headaches are temporary headaches triggered by coughing or sneezing that last just a few minutes or a couple hours and go away when the main problem (the cough, for example) is cured.

Exercise headaches typically cause pain on both sides of your head, come on during or after exercise, and can last just a few minutes or up to 48 hours, states the American Migraine Foundation.

It might sound like a joke, but it’s not: If you get a severe headache on both sides of your head right before or after orgasm, you could be in the 1-1.6% of the population that experiences frustrating (but harmless, and treatable) sex headaches.

If you have ever shouted “brain freeze!” while slurping a milkshake a little too fast, you might have had the short, stabbing headache known scientifically as a “cold-stimulus headache,” caused when cold temperatures temporarily restrict blood flow.

Harmless external pressure headaches are marked by short-lived head pain that pops up when something is literally pressing on your head, like a headband or helmet, and go away when the pressure is taken away, according to the journal Current Pain and Medical Reports.

Very brief (often just seconds-long) ice pick headaches, also known as “primary stabbing headaches,” might happen up to three times per day, and are only a cause for concern if they’re a symptom of another condition, notes the American Migraine Foundation.

A nummular headache causes severe pain on just one very specific spot, sometimes as small as a coin, that can last up to several months, or crop up in short bursts of seconds or minutes, though they are not well understood by scientists, reports a Neurological Bulletin paper.

Hypnic headaches, or “alarm clock headache,” wake you up from sleep for 15 minutes to four hours at a time, states the American Migraine Foundation, and, oddly, can often be treated with caffeine before bed.

New daily persistent headaches (NDPH) are just what they sound like—chronic headaches that strike nearly every day (or at least 15 days per month, for three months) in people who have never had headaches before. The Annals of Indian Neuropsychology Academy advises that this is more of a “syndrome” than a diagnosis, because it usually implies you have some other kind of headache condition, like migraines or tension headaches.

A few common ones include:

Sinus headaches can imitate migraine symptoms, like watering eyes, stuffy nose, and sinus pressure or pain. Sinus headaches, however, are relatively rare, result from sinus infections, and typically go away when the infection’s cured. In fact, many people who think they have sinus headaches actually have migraines. Telltale signs that that’s the case is that you have forehead and facial pressure over the sinuses, but no fever, changes in smell, or foul-smelling breath.

As you might guess, post-traumatic headaches result from trauma. The American Migraine Foundation notes that they’ve often described as feeling like both a tension headache and a migraine headache. While they often clear up within a few months, there’s a chance they last longer. And when that’s the case, it’s a good idea to speak to a doctor about your symptoms.

Medication-overuse headaches are also known as rebound headaches because they’re a result of taking a medication more often than your doctor recommends. According to Mayo Clinic, any medication you take for a headache (from over-the-counter pain relievers to preventive migraine drugs) can cause rebound headaches, but only if you have a headache condition. In other words, medication overuse won’t cause a headache if you didn’t already get them before. Luckily, they’ll usually go away if you stop taking the medication.

The only way to be sure what kind of a headache you have is to see a doctor, but you can help your doctor make a diagnosis by keeping tabs on your symptoms with a headache diary.

You should record things like:

  • what your headache feels like

  • what other symptoms come along with it

  • how long your headache pain and other symptoms last

  • how often your headache strikes

A doctor can take a cohesive look at your headache patterns, your family history, and the results of any required tests and examinations to help you figure out what kind of headache you have—so you can get treatment.

How can you tell if you have migraines versus a different type of headache? Without the help of a doctor, it can be difficult to tell the difference between, say, chronic migraines, and another serious condition. That’s why it’s important to talk about your condition with a doctor.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Photo by Aiony Haust on Unsplash.

Muscles related to pain in the Eye socket

The eye is very sensitive to light and other factors.

It lacks the protections of skin, injury of eyes. The intensive pain of the eye is very  rare.

The eye involved the behind cornea, central whites of the eye. Any infection is very cornea, iris and inflammation.

Conjunctivitis, Keratitis, Scleritis, Neuritis, Blepharitis are the main causes of the treatment.

Some of the diseases that may cause the eyeball pain.

The main causes of the pain are the contact lens keratitis Corneal abrasion, photokeratitis, corneal ulceration, sclera, and Uvea.

Eye cavity and internal structures are also very important for this.

Optic nerves and eyelids are the main factors for this. Inverted eyelid and Everted eyelid are the conditions which include eye inflammation.

Pain around the eye is also very important for this.

Below the maxillary sinus and the teeth, there is also the eyelid which plays an important in its treatment areas. The skull itself has many superficial muscles.

The unnecessary situation of this causes the pain of eyeball.

The possible reason for the eye pain is the Sinusitis, Rhinitis, Cluster headaches, Migraines, Toothache, Raised intracranially.

Pain around the eye socket is an issue that lot of us will have encountered sooner or later that can have numerous causes.

While this can regularly be only a minor irritation that will leave to its own gadgets, in different examples it can be a more genuine ceaseless condition.

Here we will take a gander at the conceivable reasons for eye socket pain, however in the event that the pain proceeds with, you should dependably make a point to see a specialist for an expert assessment.

Pain around the eye socket is ensured by living creature and has just a thin layer of skin to cushion it against wounding, in this manner, it is genuinely simple to bruise this part and that would make it extremely sore to touch even daintily. The pain may be joined by swelling.

The eye socket just beneath the eyebrow is the place a portion of the ethmoid sinuses are found, and consequently, sinusitis (disease or irritation of the sinuses) can cause torment around there because of the working up of the ethmoid mucosa.

A specialist may prescribe a steroid shower or other treatment. Hot showers may likewise incidentally alleviate a portion of the distress by melting and separating the bodily fluid enabling it to deplete.

A  frosty, sensitivity, or whatever other condition that reason the sinuses to plainly blocked may cause weight on the head and a slight cerebral pain around the eye socket.

Esophoria is an eye issue described by an internal deviation of the eye because of visual muscle unevenness.

This can cause pain over the eye socket as would some be able to other eye issues.

Headache can happen in any piece of the head, and this incorporates around the eye sockets. In the event that you are experiencing a headache, the torment will probably be intense and the best game-plan is to close your eyes in an obscured room.

Iris is the high tech software that works to control the brightness and blue light emitted by the screen.

It will change the color of the screen according to the surrounding and you will notice that the brightness of the screen will increase and decrease accordingly.

In this way, you will not have to suffer from any kind of strain or pain.

Specialist Answers on Eye Problems

Q1. I’m 50 years old and currently take a number of medications that can cause drowsiness. Up until the beginning of this year, I never had to wear glasses. My medication (for depression) was increased last year, and I just started taking Wellbutrin. Do you think the meds I take may be causing the blurriness I’m experiencing?

Antidepressants may cause blurred vision, although this is not very common. It is important to determine if the blurriness started at the same time you began taking the new medication. If so, the medication certainly may be causing the problem and it might be reversible upon discontinuation. If not, there are several other potential causes of blurriness at your age. The development of cataracts often causes blurriness, as they may initially cause “myopization” of your eye. In other words, you become “nearsighted” due to the optical changes in the natural lens of the eye due to cataract formation. This effect may be progressive, and therefore you may initially need a prescription to correct the problem, with adjustments as the cataract worsens over time. Another common cause of sudden blurriness is diabetes. If you have sudden changes in your blood sugar levels, which frequently occurs in people with diabetes, this may trigger the same mechanism as an early cataract and induce nearsightedness very quickly, sometimes even overnight. Another possibility is posterior vitreous detachment, which is a frequent degeneration observed after the fifth or sixth decade of life. Although in most cases posterior vitreous detachment is undetected, sometimes it may create blurriness when the macular area (a special spot on the retina) of the retina (at the back of the eye) is also affected. It is important to visit your eye care specialist to make sure that these changes are not being caused by other diseases.

Q2. I am taking Travatan Z to control my glaucoma. I’ve only been on it for six months, but I am suffering from itching and rashes mostly around my eyes, face, and scalp. I saw a dermatologist and an allergist, but both could say only that I was in contact with something in the environment. My doctor said if I stop taking Travatan Z, I could lose sight in one of my eyes, but the allergic reaction is really awful. Have you heard of such side effects with this drug?

— Luke, Louisiana

Based on the fact you are taking the glaucoma eye medication Travatan Z (travoprost), I assume that you have been diagnosed with open-angle glaucoma (also known as ocular hypertension). A rash has been reported with the use of Travatan or Travatan Z, and about one to two percent of the people who take this medication will develop it. This reaction may be due either to an allergy to the principal medication itself or to the chemical that is used to preserve it, benzalkonium chloride. In fact, benzalkonium chloride is a known allergen and people can become highly sensitive to it after long-term daily exposure.

Before you stop using Travatan Z, however, talk to your treating physician again about the rash. There are other effective medications for the management of glaucoma, depending on what drugs you may have been treated with in the past.

Q3. Years ago I had a detached retina that lasted quite a while before it was correctly diagnosed (about 18 months or more). Consequently, I’ve lost eyesight in my left eye. Have there been any new methods in regard to regenerative retinal replacement treatment or surgery? I guess I’m looking for a bionic eye, huh, doc?

Yes, you may be looking for a bionic eye or perhaps an eye transplant! Unfortunately, neither is available yet. There are interesting studies that have used special computer chips that act as receptors of light stimulus in diseased retinas, but the ability to recover vision with these devices is still very, very limited. The retina needs to be attached to the membrane underlying it (the choroid) to have appropriate nutrition. When the retina detaches, the cells within it start a process of accelerated degeneration and death as a result of becoming disconnected from their source of “food.” The retinal cells are extremely important for vision, as they are the receptors of the light that is collected in the eye. If your receptors are damaged, there are very poor possibilities for vision, even if the rest of the nerve pathway remains intact.

Moreover, the dead cells do not regenerate, which means that if we operate on the retina after the critical time has elapsed, function of the eye will not be recovered. The retina has been translocated (moved from one spot to another) in some trials in an attempt to use the remaining healthy areas of the retina in the most critical zones of vision where cells have been damaged. Again, results have not been that promising. Similarly, retina transplants do not seem to work well, as opposed to corneal transplants, which are the most frequent and successful transplants in the human body. It seems like the most effective therapy for retinal detachment is prompt reattachment within hours of detachment, while enough cells are still alive to preserve some function. A significant loss of function can be observed as soon as 48 hours after detachment.

Q4. I’ve been using reading glasses that I bought at a bookstore for more than a year. I find them helpful, but I was wondering if they could do any damage to my eyesight.

— Barbara, Delaware

Over-the-counter readers will not damage your eyes. If you use the wrong magnifying power, though, they will cause annoying symptoms such as blurred vision, fatigue, headaches, eyestrain, and so forth, which disappear when you stop wearing them. This type of eyeglass correction is recommended for individuals who have a symmetric refractive error, meaning both the right and left eye need the same power of eyeglass correction. These lenses are meant to be used by persons with presbyopia, a condition that naturally occurs after the fourth decade (40 to 45 years old), when the human eye loses the ability to focus on objects at close distances. Reading glasses are then required to supplement the eye; the magnification of the lens compensates for the inability to focus on something close. Over-the-counter readers may successfully achieve this goal if the problem is indeed presbyopia. Problems arise when a person requires a different correction in each eye. In that case, a custom-made prescription is recommended. Similarly, high refractive errors may not be correctable with these glasses, as their range of optical powers is limited. If the reading glasses’ power is too weak, a person whose vision is affected in this way may experience visual strain and/or headaches while wearing them.

It seems as though you’ve been doing well with your store-bought readers, and consequently I assume your correction is similar in both eyes, and the strength of the lenses is appropriate. However, only an optometrist or ophthalmologist can give you the correct prescription and guide you in selecting the most appropriate power of these glasses for your eyes.

Q5. I’ve experienced sudden intense pain in my left eye for the past two hours. It comes and goes and lasts in duration for up to two minutes. What could this possibly mean, and what can I do about it?

Ocular pain may come from different conditions in the eye or its vicinity. Probably one of the most feared causes of sudden pain is a glaucoma attack (also called acute angle closure glaucoma). In this disease, the intraocular pressure suddenly increases up to levels that irreversibly damage the optic nerve if left untreated for a few hours. It is accompanied by blurred vision, red eye, and sometimes nausea and vomiting. This is one of the few true eye emergencies and should be treated immediately to preserve vision. However, the pain in a glaucoma attack is usually persistent and gets worse over time, which doesn’t sound like what’s happening to you.

Other causes of sudden eye pain are optic neuritis (inflammation of the optic nerve), Tolosa-Hunt syndrome (eye pain and headache associated with inflammation of the back of the eye), or, more often, simply ocular fatigue after several hours of reading or working at a near distance without appropriate eyeglass correction. It is important to determine the type of pain you are experiencing, because if associated with headaches, it may also indicate brain disease. If pain gets worse with eye movement, it may reveal problems in the orbit (eye socket), which include infections that may spread to the nervous system. If you had any sort of trauma, the pain may be caused by a corneal abrasion (scratch of the cornea of the eye), but this type of pain should be more persistent and quite painful. Corneal infections may also induce stabbing pain in the eye.

In summary, many different conditions can produce sudden eye pain. An evaluation by an ophthalmologist who can do a thorough eye exam is the best way to find the source.

Learn more in the Everyday Health Vision Center.

An Anatomic Approach to Unexplained Ocular Pain

Diagnosing a patient withunexplained ocular pain can be time-consuming and difficult. Taking an anatomic approach and excluding causes along the way can aid in the diagnosis.


“Patients with pain are underserved. Eye pain is always diagnosable, but you have to think anatomically,” says Kathleen Digre, MD, a neuro-ophthalmologist in practice at the JohnA.MoranEyeCenter at the University of Utah.

Kimberly Cockerham, MD, agrees. She notes that there are not enough neuro-ophthalmologists to treat the number of patients with unexplained ocular pain. “A lot of general ophthalmologists are having to take on the diagnosis and treatment of these patients because it is difficult to refer,” says Dr. Cockerham, adjunct associate clinical professor at StanfordUniversity and neuro-ophthalmologist with subspecialty training in oculoplastics and orbital disease. “General ophthalmologists are, not by their own choice, managing these problems, and a decision tree can be helpful for diagnosing patients with unexplained pain.”


The Surface of the Eye

When a patient presents with ocular pain and few or no other symptoms, the first step in diagnosis is getting a history and examining the surface of the eye and the patient’s face for clues. “The anterior surface of the cornea has some of the densest nerves in the whole body,” says Daniel Durrie, MD, owner of Durrie Vision in Overland Park, Kan.

“Anything that happens on the cornea that disrupts the epithelium or stimulates those nerves can cause significant pain, so the first thing you have to do is get a history of what they were doing when they first noticed pain. Were they sweeping, working on metal or riding on a motorcycle when the pain started? The history is extremely critical for diagnosing a foreign body or conditions that occur after being struck in the eye.”

The history is also important for diagnosing recurrent erosion syndrome, which is most painful when a patient wakes up and then improves throughout the day. “This can be diagnosed almost from the history alone, because the patient reports that the eye waters and he or she feels like something is in the eye in the morning, and both symptoms get better as the day goes on,” Dr. Durrie says.

Patients with shingles who have had lesions around their lids and corneas can experience eye pain even years after the acute inflammation has resolved. “History can diagnose this condition, too. Sometimes, in an early episode of shingles, the only symptom is pain that seems to be out of proportion to what you see,” Dr. Durrie adds.

Dr. Cockerham, who is in private practice in Los Altos, Calif., adds that it is also important to examine patients’ facial features. For example, bulging of the eyes or eyelid retraction is suggestive of thyroid disease. She also looks for abnormalities in contours, such as the lacrimal gland bulging out more on one side than the other or the eye being pushed in or down more on one side than the other, and she examines the temporalis fossa. “In patients with meningiomas or fibrous dysplasia, the temporalis fossa can start to become flat or convex instead of concave,” she explains.

Examining the appearance of the vessels in the eye can also aid in the diagnosis. Patients with a carotid-cavernous fistula can present with pain and bulging of the eye due to dilatation of the veins draining the eye. “Inflamed vessels, particularly over the muscles, could be associated with a myositis or thyroid eye disease,” adds Dr. Cockerham.

According to Mark Packer, MD, the most common ocular finding accompanying pain is dry eye. “These patients may have a poor or partial blink, and they may have eyelid abnormalities,” says Dr. Packer, who is a clinical associate professor of ophthalmology at Oregon Health and ScienceUniversity and in private practice at Drs. Fine, Hoffman, and Packer, in Eugene, Ore. “Dry eye is commonly treated with Restasis and artificial tears. I use topical steroids briefly at the initiation of treatment. Ninety percent of my dry-eye patients respond to Restasis, but it takes a while to work. In fact, it often takes two to three months to reach its effect.”

Dr. Cockerham notes that dry eye is a bilaterally symmetric process. If a patient’s Schirmer test measurement is 2 in one eye and 10 or 20 in the other, it could be indicative of a tumor of the lacrimal gland or in the brain that is affecting the complex neural innervations pathway of the lacrimal gland.

Bacterial, viral and fungal keratitis can also cause pain; however, these patients typically have accompanying symptoms. “Acanthamoeba keratitis can be very painful and is often misdiagnosed as a bacterial or viral keratitis,” Dr. Packer says. “If it is mistreated with steroids, it can be made worse. This condition is typically seen in contact lens wearers who have used tap water to rinse their contacts, and confocal microscopy is needed to diagnose Acanthamoeba infection.”


Intraocular Causes

If a diagnosis cannot be made after taking the history and examining the face and surface of the eye, intraocular causes, such as glaucoma, should be considered. “Then, there are conditions that cause intermittent pain, where the eye exam is actually normal but only at the time you are examining the patient,” says Andrew Lee, MD, chair of ophthalmology at the Methodist Hospital and professor of ophthalmology at Weill Cornell College of Medicine in Houston. These conditions include uveitis and intermittent angle-closure glaucoma.”

Another intraocular cause of pain is Posner-Schlossman syndrome. “Out of the blue, these people de-velop a high pressure in the eye that is due to inflammation of the trabecular meshwork. When you look at them, the eye looks quiet, and there is no redness, but the pressure is really high. They respond to steroids immediately,” Dr. Packer explains.

Another inflammatory condition that can cause eye pain is giant cell arteritis, which is most commonly found in elderly patients. “To look for inflammation, we can do a sedimentation rate and a C-reactive protein,” says Dr. Lee. Treatment for giant cell arteritis includes oral steroids. If left untreated, these patients could experience visual loss or, rarely, cardiac events or a stroke.

Another condition to consider is pituitary adenoma. According to Dr. Cockerham, if a patient has a tumor on his pituitary gland and hits his head or takes a large dose of aspirin or other blood thinners, the tumor can start to bleed into itself (pituitary apoplexy). “These patients may present with pain initially without the other classic symptoms of double vision and bitemporal visual field defect,” she explains.


Headache Syndromes

Headache syndromes, while not an eye condition, are a significant source of eye pain. “Many headache syndromes can be diagnosed just by history, and criteria for diagnosis were developed at a consensus conference of the International Headache Society, Dr. Lee explains. “This society defines the criteria for conditions that can cause eye pain but are really headache syndromes. The three most common are migraine, tension and cluster. They can be associated with eye pain because the pain itself is in the eye, even though the pain is not from the eye.”

According to Dr. Digre, migraine is the most common disorder, affecting 20 percent of women and 10 percent of men. Migraines can cause pain in the eye or orbit, and they can occur with or without aura. “These patients are light sensitive, may be sound sensitive, may have throbbing pain, and may have some nausea. Then, they have a totally normal eye exam,” she says.

Cluster headache can occur directly over the eye and is more common in men. “You may see an associated Horner’s syndrome during the attack and sometimes even in between attacks. These patients present with excruciating eye pain, tearing, lacrimation, rhinorrhea, stuffiness of the nose, possibly swelling around the lid, and maybe some conjunctival redness,” she adds.

Another headache disorder, hemicrania and paroxysmal hemicrania, is most often seen in middle-aged women. Attacks typically occur five to 40 times per day, and each attack lasts between two and 45 minutes. Hemicrania continua and chronic paroxysmal hemicrania can cause continuous pain around the face and eye. Fortunately, these disorders can be effectively treated with indomethacin.

Another, less common headache disorder is short-lasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). “This rare condition is seen mostly in men, but can occur in women. It lasts seconds and goes away, and it can occur 100 or 150 times in a day. You can even have it without the conjunctival injection and tearing, and that’s called SUNA,” Dr. Digre explains.

During the initial exam, Dr. Cockerham asks patients to point to the location of the pain. “Sometimes, with unexplained pain, they will point right at their trochlea. Trochleitis is a condition where the trochlea becomes inflamed,” she says. Trochleitis is characterized by localized swelling, tenderness and severe pain superomedially. It has been associated with triggering or worsening migraine headaches in patients with pre-existing migraines.1

“Then, there are other patients who don’t meet the criteria for a specific headache diagnosis according to IHS criteria, who have normal eye examinations and don’t have any other evidence for an intraocular cause. Those patients sometimes have an intraorbital cause, such as myositis or orbital inflammatory pseudotumor. These patients typically have severe pain that is made worse with eye movement,” Dr. Lee explains. In addition, some patients with optic neuritis can present with the eye pain before the typical vision loss.

Imaging studies, such as a CT scan, MRI, or ultrasound can confirm the presence of inflammation. According to Dr. Lee, treatment includes nonsteroidals or a short course of steroids.


Other Neurologic Causes

The trigeminal nerve provides sensation to the eye, face, and most of the head. “Some patients who have trigeminal pain or neuropathic pain feel it in their eyes. The greater occipital nerve can also be involved and radiate pain to the eye,” Dr. Lee explains.

Dr. Digre adds, “The trigeminal system, whether it is trigeminal neuralgia or trigeminal activation from migraine, can cause a lot of problems with pain in the eye, and there won’t be any ophthalmic findings. Everything will look completely normal. I see a lot of eye pain from trigeminal nerve disorders; it’s pretty common. You have to think about it every time you see a patient.”

Dr. Digre explains that the eyes are innervated by the first division of the trigeminal system, and this same division is also responsible for all of the pain in the cranial cavity, including the dural vessels and the meninges that cover the brain. “People can have something going on in their heads that manifests itself as pain in the eye, she says. “This system is very complex because it has other nuclei that even go down into the cervical system—C1 and C2. If there is a problem even in C1 or C2, I’ve seen people present with eye pain when they actually had a problem at the cervical cranial junction. One woman had pannus of her odontoid that was compressing her C1-2 region, and she presented with eye pain.”

A 2009 report by Perry Rosenthal, MD, and colleagues described patients who have corneal pain suggestive of dry eye, with no clinical signs.2 The authors suggest that this is a disease in its own right. “It’s a trigeminal disorder. It isn’t just dry eye because when you do dry eye testing, these patients don’t have the results that go along with it. I think this condition is really underdiagnosed. The nerve endings are extra sensitive, and things like zoster and diabetes can cause it. Dr. Rosenthal has even diagnosed this condition in refractive surgery patients,” Dr. Digre says.

Researchers in Finland have also observed this condition in refractive surgery patients.3 In 2007, a group described 20 eyes in 20 patients who underwent LASIK for high myopia. They found that the majority of these patients reported ongoing dry-eye symptoms that were not demonstrated through objective clinical signs. They concluded that the symptoms represent a form of corneal neuropathy rather than dry eye syndrome.

“It seems to be related to abnormal nerve re-growth, but I’ve done more than 20,000 LASIK procedures, and I have never seen it,” Dr. Durrie says.

Although isolated ocular pain can be difficult to diagnose, it is often not serious and is easily treated. “If you have a normal eye exam, your history doesn’t suggest any defined headache syndrome, and there is no other finding, the chance of it being something bad is extremely low,” Dr. Lee says. “It is extremely unlikely that someone who has an isolated eye pain would have something serious, except elderly people who might have giant cell arteritis or patients who have neuropathic pain. Those are the things that ophthalmologists need to worry about.”


1. Yanguela J, Pareja JA, Lopez N, et al. Trochleitis and migraine headache. Neurology 2002;58:802-805.

2. Rosenthal P, Baran I, Jacobs DS. Corneal pain without stain: Is it real? Ocul Surf 2009;7(1):28-40.

3. Tuisku IS, Lindbohm N, Wilson SE, Tervo TM. Dry eye and corneal sensitivity after high myopic LASIK. J Refract Surg 2007;23(4):338-342.

Cervicocranialgia – treatment, symptoms, causes, diagnosis

Headaches in a certain percentage of cases are caused by problems in the neck and are called cervicocranialgia . These pains are usually associated with changes in the structures of the neck or head, or may be reflected (for example, from the upper back, jaw, or shoulders).

Sudden onset of neck and head pain is often associated with injury from contact sports, traffic accidents, weightlifting, bending forward or sideways, twisting the neck, or a combination of these movements.In addition, in the presence of damage to the ligamentous apparatus, pain in the neck and head can occur even after sneezing due to a strong adaptive muscle spasm. Also, one of the most common causes of acute neck pain radiating to the head, shoulder, arm, forearm is a herniated disc, subluxation of the facet joints. Gradual onset of neck and head pain often occurs in patients who sit at a computer for a long time, repetitive neck tilts, poor posture, or a combination of these factors. Also a common cause of pain may be a herniated disc.In older patients with gradual onset of neck pain, one of the most likely causes of symptoms is degenerative changes in the spine.


Headaches have many causes and are often associated with certain neck pains. Such headaches are known as cervicogenic headaches and are often caused by myofascial pain and muscle-tonic syndromes of various etiologies and types. But it must be borne in mind that pain in the neck and at the same time in the head can be a sign of serious diseases such as, for example, meningitis or a brain tumor, and can also be caused by a neck injury and this must be taken into account when diagnosing cervicocranialgia .

Muscular causes of cervicocranialgia

Problems in the muscles can lead to these pains, especially if there are problems in the muscles running from the lower jaw to the side of the head. These muscles are connected to the base of the skull and can be spasmodic due to poor posture, overuse, or stress. Usually, a headache associated with muscle problems is also felt as pain when moving in the shoulder. When pressure is applied to the area of ​​pain (in the neck or shoulder), the headache tends to change.The pain can be mild to moderate or intense, lasting from several hours to several weeks.

There are three main nerves, C1, C2, C3, which run directly into the head from the cervical spine.

These nerves innervate the muscles around the skull at the top of the neck and can spasm as a result of inflammation or prolonged stress. Muscles such as Semispinalis capitus, Capitus long, and Longus Capitus, Capitus Lateralis are responsible for moving the head backward, forward, and sideways, respectively.The trigeminal nerve innervates the facial muscles, while the second cranial nerve provides sensitivity to the back of the head. These two nerves are located in the upper part of the neck, so any damage or injury in this area can lead to pain that can radiate from the lower back of the head and radiate to the upper part of the head, eyes, and face. Neck and head pain can also be caused by myofascial syndromes associated with muscles such as Upper Trapezius, Sternocleidomastoid, Splenius Capitis, Splenius Cervicis, Semispinalis Capitis, Semispinalis Cervicis, Longus Capitis, Longus Colli, Multifidioid and Rotis.

Degenerative changes in the spine

Structural involutional degenerative changes in the intervertebral discs and vertebrae can cause reflected head pain, usually in the back of the head.

Herniated disc in the cervical spine is one of the most common causes of neck pain, with possible radiation to the arm, shoulder and often to the head, but more often the headache is due to secondary muscle spasm. The pain can increase with palpation pressure in the neck and often the pain is accompanied by a limitation of mobility in the neck.Sometimes the pain may be absent in the neck, but there may be only pain in the arm or only a headache. As a rule, pain in the arm is accompanied by numbness, a tingling sensation in the arm. Pain caused by a herniated disc is often aggravated by prolonged static loads (for example, when sitting), when turning the head.

Neck Injury

Injuries to muscles, ligaments, tendons, joints, discs and nerves in the upper part of the neck can lead to chronic pain in the neck and head. The most common injuries are “whiplash” that occurs during falls or road traffic accidents, or sports injuries such as subluxation of the “facet joints”, which respond well to manual manipulation.Poor posture, repetitive movement and stress can also cause facet joint subluxation, which can lead to localized neck pain and chronic headaches.

Sprain of ligaments

Tears (tears) of the connective tissue surrounding the articular joints are usually the result of excessive stretching of the tissues during twisting, bending and extension, especially against the background of poor posture. A sprain usually presents with neck pain on one side, which can radiate to the lower part of the head.Typically, these conditions are accompanied by muscle spasm.

Injuries to the facet joints often result from sudden neck movements, collisions during contact sports. Usually in such cases there is a constant, dull pain that can be localized in the back of the head, upper forehead, behind the eye, in the temple area and, less often, around the jaw or ear. Headache is usually associated with neck pain, stiffness in the neck, and difficulty turning the neck.Pain may increase with palpation in the cervical spine, usually on one side of the neck, just below the base of the skull. Sometimes there may also be symptoms such as a tingling sensation, numbness, nausea, or mild dizziness.

Arthritis of the cervical spine

The most common cause of chronic neck pain leading to headache is osteoarthritis, which is caused by degenerative changes in the joints of the vertebrae. Usually, only changes in the joints of the three upper vertebrae of the neck are the cause of cervicogenic headaches.Osteoarthritis of the neck (spondylosis) is a degenerative change in the facet joints that leads to the formation of osteophytes and bulging discs. These degenerative processes can generate chronic, dull, or sharp neck pain and pain in the back of the head.

In addition to involutional degenerative changes in the cervical spine, changes in the joints can also be caused by systemic diseases such as rheumatoid arthritis or psoriatic arthritis, in which inflammation in the joints can cause pain in the neck and cause chronic cervicogenic headache.Such causes of cervicogenic headaches are much less common than osteoarthritis (spondylosis), but pain manifestations caused by inflammatory diseases of the neck joints are more intense and prolonged.

Serious illnesses

Many serious illnesses or conditions can lead to chronic headaches and are often accompanied by neck pain. These are diseases such as brain tumors, brain abscesses localized in the occipital region, tumors of the cervical spine, and Paget’s disease.Acute pain in the head and neck can be caused by infectious diseases such as meningitis. In addition, acute pain in the neck and head can be caused by fractures of the spine due to injuries, sports, traffic accidents. As a rule, pain syndrome is acute and is preceded by an episode of trauma. With a fracture, both pain in the neck and head and symptoms such as impaired movement in the limbs, impaired sensitivity may appear. Therefore, when diagnosing pain in the neck and head, it is necessary to take into account the possible genesis of pain in the neck and head, which requires emergency medical care.


Head fights associated with the neck ( cervicocranialgia ), as a rule, has a certain connection with a neck injury and in such cases the headache can be on one side, the pain can be at the base of the skull, forehead, in the parietal part around the eyes. As a rule, the pain begins in the neck area, and in most cases is not pulsating or sharp.

Other features of headaches associated with neck pain are the frequent presence of symptoms such as nausea, sensitivity to sound and light, dizziness, difficulty swallowing, blurred vision (often only on the side of the headache), watery eyes and sometimes vomiting, in in cases where the pain is of a serious origin.Sometimes there is swelling around the eye on the side of the head where the pain is felt. The pain may worsen when the shoulders are moved. The intensity of headaches can be mild to severe, lasting from several hours to several days or even weeks.

Headaches associated with the neck must have at least one of the following properties:

1. The headache must be preceded by:

  • Neck movement
  • Prolonged uncomfortable head position
  • Pressure on the upper half of the neck or base of the skull on the side of the headache

2.Limited range of motion in the neck

3. Pain in the neck, shoulder or arm

If all three properties are present, then it is most likely that the headache is due to problems in the neck.

Characteristics of headaches associated with the neck

  • Often history of neck trauma (contusion of the cervical spine, sprain, subluxation of the facet joints)
  • Unilateral headache
  • Sometimes pain can be on both sides
  • Pain localized at the base of the skull, in the forehead, on the sides of the head or around the eyes
  • Pain can last for hours or days
  • Headache usually begins in the neck
  • Moderate to severe headache
  • Headache, non-throbbing
  • Pain is not sharp

Other features that occur with headaches associated with the neck:

  • Nausea
  • Sound sensitivity
  • Light sensitivity
  • Dizziness
  • Difficulty swallowing
  • Blurred vision on the side of the headache
  • Vomiting
  • Lachrymation on the side of the headache
  • Swelling around the eyes on the side of the headache

Diagnostics and treatment

Diagnosis of cervicocranialgia presupposes, first of all, the exclusion of serious causes of headaches such as brain tumors, meningitis or spinal injuries.Based on the medical history, study of symptoms and physical examination, the doctor, in most cases, can make a preliminary diagnosis and determine the required amount of examination. Instrumental research methods (X-ray, CT, MRI) make it possible to make an accurate diagnosis. If it is necessary to carry out a differential diagnosis, laboratory research methods can be prescribed.

Treatment of cervicocranialgia depends on the genesis of pain and, as a rule, is effective in using a set of therapeutic measures (drug treatment, physiotherapy, massage, acupuncture and exercise therapy).

90,000 Does the head on the right hurt? Get rid of pain in 1 dose

Pain in the head on the right

Unilateral headaches are a symptom of migraines, overwork or more serious illnesses. When headaches on the right side are common, pain relievers do not help. If over time the attacks are repeated more and more often, and the pain intensifies, you should immediately seek medical help. Ignoring the condition or self-medication leads to the progression of diseases.

Description of the migraine condition

Migraine may come on suddenly, gradually increase or decrease. To such a symptom as pain in the right hemisphere of the head, concomitant ones can be added:
• deterioration of vision and hearing;
• photophobia and the appearance of “flies” before the eyes;
• nausea and vomiting.

Pain can be prolonged or repeated in short bouts up to 15 times a day. Pupils narrow, lacrimation increases, eyes turn red, nasal congestion appears.The state cannot be ignored. It is often the cause of the disability of women.

Signs of cluster pathology

At first you notice that your head is throbbing without pain. The state appears suddenly, as it disappears. Over time, a one-sided headache appears. It is localized in a certain area near the eye, ear, on the back of the head or at the crown. Vessels in the eyes burst, the skin of the face turns red, the pressure rises, and more and more blood rushes to the head.

The nature of cluster pain is poorly understood.The intensity of the attacks is not reduced by pain relievers and antispasmodics. Doctors advise to provide the patient with complete rest, dim light and silence. So you can alleviate the condition a little, but not get rid of the disease.

What to do when the right side of your head hurts?

You can not take drugs uncontrollably, trying to improve your own condition. It is necessary to make an appointment with a neurologist. The network of medical centers “DorsumMed” employs highly qualified specialists.They are equipped with all means of accurate diagnostics. To get an appointment, fill out the fields of the proposed form. The manager of the company will call you back to suggest a convenient time and advise on any issues that have arisen.

When your face hurts | Official site of the Scientific Center of Neurology

V.M. Tyurnikov
Candidate of Medical Sciences, Senior Researcher

State Research Institute of Neurology, RAMS

One of the most common types of facial pain is trigeminal neuralgia, which received its name in 1671, and for the first time this disease was described in his letters back in the first century of the last millennium the healer Aretaeus.He described in detail the disease, which proceeds with excruciating bouts of pain in half of the face.

The prevalence of trigeminal neuralgia (NTN) is quite high and amounts to 30-50 patients per 100,000 population, and the incidence, according to WHO, is in the range of 2-4 people per 10,000 population. According to the WHO, more than 1 million people worldwide suffer from trigeminal neuralgia.

More often this suffering occurs in women in the right half of the face at the age of 50 – 70 years.The development of the disease is facilitated by various vascular, endocrine-metabolic, allergic disorders, as well as psychogenic factors. But most often the cause of the disease cannot be found out.

Painful attacks on the patient’s face (lips, eyes, nose, upper and lower jaw, gums, tongue) can occur spontaneously or be provoked by talking, chewing, brushing teeth, touching certain parts of the face (trigger points). Their frequency varies from single to tens and hundreds per day.During the period of exacerbation, more often in the cold season, attacks become more frequent. This pain is so strong that patients cannot concentrate on something else. Patients at this time are in constant tension, lock in on their sensations and exist, not noticing anything around, only constantly waiting for the next attack. Sometimes the sick, unable to endure any more pain, commit suicide. Even during periods of remission, patients live in fear, fearing an exacerbation of the disease, walk, covering their heads even in summer, do not touch the sick half of the face, do not brush their teeth, do not chew on the affected side.

The first visit often happens not to a neurologist, but to a dentist. This is due to the fact that the pain distribution zone is located not only on the face, but also in the oral cavity. Very often, healthy teeth are removed by mistake on the affected side.

Despite the fact that the disease has been known for a long time, there is still no consensus about the causes of its occurrence.

Currently, many researchers believe that neuralgia can be triggered by pressure from a blood vessel (artery or vein) on a part of the nerve, thus causing a change in the nerve sheath (demyelination).Changing the sheath of the nerve, in turn, leads to a change in the passage of nerve impulses, causing the appearance of pathological excitability of the nerve and, ultimately, to the occurrence of pain. The cause of a local change in the sheath of the nerve can also be the pressure of the tumor on the nerve, the pressure by the wall of the narrowed bone canal through which the nerve passes. The membrane can be damaged in viral diseases (herpes) or in multiple sclerosis.

Treatment of trigeminal neuralgia is diverse.Anticonvulsants are prescribed to prevent the development of an attack of pain (carbamazepine, finlepsin, tegretol), vascular drugs, antispasmodics, sedatives. Physiotherapeutic procedures (applications with paraffin, Bernard currents), acupuncture are widely used.

Traditional medicine recommends:

  • Yarrow (herb): 1 tablespoon of dry herb for 1 cup of boiling water. Insist 1 hour. Take 1 tbsp. spoon 3-4 times a day.

  • Highlander amphibians (root): Boil 1 teaspoon of root for 10 minutes in 1.5 cups of water, leave for 2 hours, drain. Take 1/2 cup 3 times a day.

  • Cut the hard-boiled egg in half and immediately apply both halves to the area where the pain is most felt. Wait until the egg has cooled, the pain should disappear.

For the treatment of neuralgia, laser radiation is applied to the skin along the fields in the area of ​​the exit of the branches of the trigeminal nerve from the skull.

A number of authors recommend carrying out efferent methods of therapy (plasmapheresis, hemosorption). Despite the variety of conservative methods of treatment, including medical scratching, physiotherapy, traditional medicine, the main method of treatment today remains surgical. The operation relieves the patient from pain forever or for a long time. But it is precisely the pain that is the main complaint of the patient.

Alcohol-novocaine blockades at the exit points of the branches of the trigeminal nerve on the face are widely used to relieve pain or reduce pain at least for a short time.Unfortunately, even with an effective blockade, it lasts for a short time and pains recur. The therapeutic effectiveness of repeated blockades decreases with each time, the duration of remission (cessation of pain) also decreases.

The search for the most effective and safe method of surgical treatment of trigeminal neuralgia has been going on for over a century. The first attempts at surgical treatment were undertaken in the middle of the 18th century and were often dramatic and fatal.To influence the trigeminal nerve, craniotomy was performed, often accompanied by life-threatening bleeding. After the operation, many patients developed complications accompanied by paresis, paralysis, and visual impairments. Even in the 1950s and 1960s, after open access operations, a large percentage of serious complications were observed, and postoperative mortality reached 2-3%. Surgical methods of treatment were gradually improved and became more and more safe.

Currently, two methods of surgical treatment are widely used in the world.

The first is microvascular decompression of the trigeminal nerve root. Microvascular decompression consists in trepanation of the posterior cranial fossa, revision of the relationship between the trigeminal nerve root, superior and inferior anterior cerebellar arteries, and superior petrosal vein. When the root is compressed by the vessels, they are isolated, and a gasket is placed between the vessels and the root, preventing contact between them and the effect of the vessel on the root.

However, neurovascular conflict is not always the cause of the disease.In addition, in patients suffering from severe concomitant somatic pathology, and patients in old age, this operation is risky.

Currently, in our country and abroad, one of the most common methods of treating trigeminal neuralgia is percutaneous radiofrequency destruction of the trigeminal nerve roots.

This method is the most effective, practically does not have serious complications. Radiofrequency destruction is based on the physical principle of thermocoagulation and is based on the effect of the release of thermal energy when ultrahigh frequency currents pass through biological tissues.An electrode connected to a current generator is brought to the destruction site through an insulated cannula. The intensity of tissue heating depends on its resistance. An electric current flows between an active or damaging electrode immersed in body tissue and an indifferent or scattered electrode. Heat production, and therefore tissue destruction, occurs only around the non-insulated tip of the active electrode. The main advantage of the radiofrequency thermal destruction method is that the size of the damaged zone can be adequately controlled, and the electrode with a thermal sensor registers the temperature in the damaged zone.It is possible to set the exact time of damage, and control of electrical stimulation and resistance level allows you to correctly and accurately position the electrode. The use of local anesthesia provides a short recovery period, and if necessary, repeated sessions of radiofrequency thermal destruction are possible.

The criteria for selecting patients for the radiofrequency destruction technique are the duration of the pain syndrome for more than 4-12 months; unstable effect or its absence after drug therapy; absence of gross violations of anatomical relationships in the skull.

Neurosurgeons still continue to improve existing surgical procedures, striving for an ideal surgical operation that would be safe for the patient, relieve pain forever, without causing any complications.

In recent years, new approaches have appeared in the treatment of trigeminal neuralgia:

  • Stereotactic radiosurgery (gamma knife) is a bloodless method of destroying the sensitive root using focused gamma radiation.

  • Epidural neurostimulation of the motor cortex: a special eight-contact electrode is installed under the skull bone on the cerebral membrane. Pain regression occurs within a few minutes and continues for many hours after the termination of electrical stimulation. The effectiveness of this method is explained by an increase in cerebral blood flow in the subcortical structures.

Thus, today medicine has a wide range of conservative and surgical methods for treating trigeminal neuralgia.

At the initial stage of the disease, after a standard neurological and general examination, drug therapy, physiotherapy, blockade of the peripheral branches of the trigeminal nerve are recommended, and only after a few months of ineffective treatment, one of the neurosurgical methods of treatment is indicated.

Indications for each of them depend on the duration of the disease, the patient’s age, the presence of concomitant diseases. The success of surgical treatment depends on a clear diagnosis, careful selection of patients and strict adherence to surgical techniques.

© Newspaper “Academy of Good Health”, 2005, No. 8


Ismankulov “Eye Diseases”. Chapter 16. Pathology of the orbit

Ismankulov “Eye Diseases”. Chapter 16. Pathology of the orbit

  • Orbit development anomalies
  • Inflammatory diseases of the orbit
  • Orbital tumors
  • Cysts


Pathological processes in the orbit can be caused by congenital anomalies, inflammatory, tumor changes, as well as trauma and general diseases.Diseases of orbita manifest a whole series of symptoms:


  • Exophthalmus of varying degrees and very rarely enophthalmus. Exophthalmos appears in connection with an increase in the cavity of the orbit in tumors, including in the case of tumors in the bones of the upper jaw, edema, thrombophlebitis, due to protrusion of the walls during inflammatory processes, tumors of the walls or sinus sinuses in children, dysplasia of the upper jaw, fibroids secondary deformations from compression and due to many other reasons.Enophthalmos occurs with injuries, when bone fragments diverge and the volume of the orbit increases and with atrophy of the orbital tissue, (small in Horner’s syndrome.) To diagnose exophthalmos and its dynamics, use the Hertel exophthalmometer;
  • Limitation of the mobility of the eyeball and its displacement. The displacement is accompanied by a restriction of mobility in the opposite direction of the displacement of the eye. When the eyeball is displaced, double vision is often observed. If the process is localized in the area of ​​the muscle funnel, then in the initial stages, the mobility of the eye can be completely preserved;
  • Decrease in the ability to reposition the eyeball;
  • Changes in eye refraction and decreased visual function.A decrease in visual functions may be associated with compression of the optic nerve, with a change in the retina – hemorrhage, detachment, etc.;
  • Swelling of the eyelids and mucous membranes;
  • Pains of varying intensity, local and radiating to the teeth, upper jaw, to the occiput, to the temple;
  • Paresthesia in the region of the first and second branches of the trigeminal nerve;
  • Ptosis.
  • General phenomena that are expressed in an increase in temperature, in a slowdown or acceleration of the pulse, nausea, vomiting, which occur during inflammatory processes in the orbit (phlegmon of the orbit, osteoperiostitis) and the growth of tumors into the intracranial cavity.

Orbital anomalies are very rare. The close relationship and functional connection of the organs and tissues of the orbit with other parts of the head explain the frequent participation of the orbits and eyeballs in the congenital pathology of the skull.

Anencephaly – the absence of the cranial vault and brain above the level of the cerebellum. At the same time, the eye sockets are reduced in size, there is a pronounced exophthalmos. There may be a congenital absence of eye sockets, but more often their underdevelopment. This occurs with anomalies such as anophthalmos, microphthalmos, cystic eye.A decrease in orbits is observed with craniostenosis, with progressive hemiatrophy of the face. Widely spaced eye sockets occur with congenital hydrocephalus, craniostenosis, Cruson’s disease. The expansion of the size of the orbit is observed with congenital hydrophthalmos. The frequency of coincidence of congenital anomalies of the orbit, eye and its appendages with changes in the palate and upper jaw is noted and this is explained by their common origin from the derivatives of the first branchial arch. The most common are the violation of the development of the palate – its cleavage, non-union – the cleft lip and cleft palate.


Inflammatory diseases of the orbit are the most dangerous of the eye diseases, because they not only threaten the eyesight, but often the patient’s life. Inflammatory diseases of the orbit occur, as a rule, with severe pain in the orbit, headaches, general malaise and anxiety, fever, sleep and appetite disturbances. The causes of inflammatory processes in the orbit are very diverse: more often they are diseases of the paranasal sinuses, especially in children, erysipelas, boils and abscesses of the face and scalp, inflammation of the lacrimal sac, various inflammatory diseases of the dentoalveolar system: acute and chronic percementitis, peri-root granulomas, osteomyelitis jaws, phlegmon and abscesses of the maxillofacial region, neck, trauma, metastases, infections, tuberculosis, syphilis, acute infectious diseases (measles, influenza, typhus, tonsillitis, scarlet fever, etc.)). The spread of the inflammatory process into the orbit occurs by contact on the bone wall and periosteum (per continuitatem), through small venous infected vessels with thrombophlebitis, in cases of general infection by hematogenous-metastatic route. Of known importance for the transmission of infection per continuitatem is the anatomical structure of the bone cover, which separates the bottom of the orbit from the maxillary cavity, and the latter from the holes of molars and premolars. Here, the bone cover is very thin and porous, and sometimes the mucous membrane of the maxillary sinus lies directly on the tops of the roots.The holes protruding into the sinus have holes through which the periosteum of the tooth root comes into contact with the sinus mucosa. As a result, inflammatory processes occur in it. Sometimes, when these teeth are removed, perforation of the sinus floor is possible with the formation of a fistulous tract and, as a result, the occurrence of inflammatory processes in it.

From the maxillary cavity into the orbit through the wall of the upper jaw, a venous branch goes into the facial vein, then passes through the anastomoses through the lower orbital fissure, reaching the upper and lower orbital veins.There is also a venous branch, which, by piercing the lower wall of the orbit, opens into the lower orbital vein. All venous formations of the maxillofacial region are intimately connected with the pterygopalatine plexus, and the latter through the middle veins of the dura mater with the cranial cavity and through the orbital veins with the cavernous sinus. When the veins are involved in the inflammatory process (phlebitis), thrombi are formed, and the absence of the valve system in the veins contributes to the rapid migration of the thrombus. An infectious inflammatory process can simultaneously affect the bones of the orbit and its contents: orbital tissue, muscles, blood vessels, nerves, or only the contents of the orbital cavity.Inflammation of the bone walls of the orbit manifests itself in the form of osteoperiostitis and subperiosteal abscesses.

Osteoperiostitis can be purulent and simple. The causes of osteoperiostitis are most often diseases of the paranasal sinuses (purulent and catarrhal). They can also occur when the lacrimal sac, skin of the eyelids and face is affected, with dental diseases, and in children under the age of 3 months – from their rudiments, with general infectious diseases – lyesa, tuberculosis, flu, etc.e. Diagnosis of osteoperiostitis is easiest if it is localized in the anterior parts of the orbit (anterior osteoperiostitis) and is very difficult when it is localized in the posterior half of the orbit at the apex (posterior osteoperiostitis).

With anterior osteoperiostitis, there is a limited or diffuse swelling along the edge of the orbit, dense and painful on palpation, without clear boundaries, passing into normal adjacent areas. The clinical picture is complemented by eyelid edema, which is more pronounced in the morning, conjunctival chemosis, injection of the conjunctival vessels, sometimes ptosis, limitation of eye mobility and diplopia.In children, if the inflammatory process has spread from the rudiments of the teeth, there is a fever, loss of appetite, swelling in the upper jaw (maxillitis), protrusion of the eyeball. The timing of the development of the disease depends on the form of inflammation and develops over a period from several days to several weeks. This periostitis is more often associated with damage to the anterior group of cells of the frontal, maxillary and anterior cells of the ethmoid labyrinth. With the development of osteoperiostitis in the posterior regions, exophthalmos is noted in the clinical picture, limitation of the mobility of the eyeball with its displacement, diplopia, sensory disorder, decreased visual acuity with central or paracentral scotoma.Changes in the optic nerve (neuritis or congestive nipple), the appearance of central and paracentral cattle are explained by mechanical compression of the optic nerve with impaired blood circulation in it, as well as toxic effects. Compression of the optic nerve is observed especially often in posterior osteoperiostitis arising on the basis of a disease of the ethmoidal sinus or posterior lattices. And especially with purulent periostitis, which, when localized in the posterior region, are often accompanied by collateral edema of retrobulbar tissue.The edema reaches a significant size, lasts a long time and, as a result, compression of the optic nerve and its atrophy. In addition, there may be a disorder of blood circulation in the optic nerve. On the fundus, a picture similar to optic neuritis. In these cases, there is a dissociation between the degree of exophthalmos and visual acuity – a small exophthalmos is combined with a sharp decrease in vision.

With a simple, non-suppurative form of osteoperiostitis, which proceed, for the most part, as a local process, the focus is absorbed and replaced by connective tissue callus.With purulent – the focus softens and pus breaks out with the formation of a fistular passage or into the orbital tissue. The process can also result in optic nerve atrophy and blindness. If purulent periostitis occurs in the upper wall of the orbit, where it spreads more often from the frontal sinus, there may be edema of the upper eyelid, hyperemia and chemosis of the conjunctiva, small exophthalmos, displacement of the eyeball downward, impaired mobility, and intracranial complications may occur, with a fatal outcome …Luetic and tuberculous osteoperiostitis of the orbit, in contrast to streptococcal and staphylococcal, which was mentioned above, are almost always localized in the antero-outer half of the orbit. (Luetic in the upper – outer section). The process usually begins with periostitis. When the process spreads to the region of the superior orbital fissure, the syndrome of the superior orbital fissure develops (unilateral ptosis, small exophthalmos, complete or partial ophthalmoplegia and neuroparalytic keratitis). Osteoperiostitis occurs in both congenital and acquired lues.In children, as a rule, it occurs as a manifestation of congenital syphilis both in the secondary and in its tertiary period, more often in the first decade of the child’s life. The disease is combined with other manifestations of congenital lues and therefore the diagnosis is not difficult. Characterized by extreme tenderness on palpation and spontaneous severe pain, especially at night. Sometimes pain may precede swelling and then there is a picture similar to trigeminal neuralgia. With syphilitic periostitis, there is often a decrease in the sensitivity of the cornea.

Tuberculous osteoperiostitis occurs mainly in children and young people, may appear after bruises. The process develops very slowly and painlessly. Therefore, children go to the doctor in the advanced stage of the disease. They are localized mainly on the lower outer or lower edge of the orbit, because these areas are dense and rich in bone marrow. In exceptional cases, they can be localized on other walls of the orbit and the source of infection can be the paranasal cavity, more often the maxillary.An autopsy occurs with the formation of a fistula. The sequesters are separated and a deep retracted scar remains, leading to deformity and eversion of the eyelids. Retrobulbar tuberculous lesion of soft tissues in children is rare, but if it occurs, then the picture resembles a picture of a slowly growing tumor of the orbit. Posterior osteoperiostitis occurs more often in old age. Characterized by the absence of pain, caseous decay, asbestosis with a breakthrough outward and the formation of a fistula, followed by scarring, which can cause eyelid deformation.It can be very difficult to differentiate periostitis from inflammation of the orbital tissue, tk. with purulent osteoperiostitis, inflammation of the orbital tissue may occur. Soreness on palpation in a certain area is characteristic of periostitis.

Treatment depends on the localization, the cause that caused the inflammatory process in the periosteum and in the bones of the walls of the orbit. It is necessary to examine the paranasal sinuses, the oral cavity (carious teeth, alveolar periostitis, etc.), the pharynx and the entire body.Antibiotics, heat and radiation procedures, sulfonamides are used inside. With tuberculous periostitis, antibacterial and specific therapy, with a non-healing fistula in the skin – opening it and removing sequesters, if necessary, plastic eyelids.

For syphilitic osteoperiostitis, specific treatment. In case of accumulation of pus, surgical intervention.

Subperiosteal abscess (abscessus subperiostalis) is most often formed during purulent processes in the paranasal sinuses and is located on the inner, upper and lower walls of the orbit, i.e.e. areas bordering the paranasal sinuses.

Rarely, but more often in children, subperiosteal abscess is associated with damage to the teeth or osteomyelitis of the upper jaw. In the latter case, there is an empyema of the maxillary or ethmoidal sinus, and then a subperiosteal abscess. Pus penetrates the periosteum through bone defects, and accumulates between the bone and the periosteum and forms an abscess. If the process is localized in the anterior section, then symptoms characteristic of osteoperiostitis are observed. If the process is located deeper, then exophthalmos is observed, displacement of the eyeball with limited mobility.As a result of compression of the optic nerve, central and peripheral vision is impaired. With subperiosteal abscesses caused by empyema of the maxillary cavity, visual disturbances are observed more often than with abscesses caused by empyema of other cavities. Subperiosteal abscesses usually occur acutely and subacutely, with a breakthrough outward or retrobulbar tissue, which can lead to phlegmon of the orbit, purulent meningitis, retrobulbar, brain abscesses and sepsis.

Treatment: early opening of the abscess, antibiotics and sulfonamides, warmth, if necessary, special and specific treatment.

Orbital phlegmon is a diffuse acute purulent diffuse inflammation of the orbital tissue with its necrotization and fusion. The causes of phlegmon are very diverse. Phlegmon can be a complication of subperiosteal abscess, osteoperiostitis. In cases of penetrating trauma to the orbit, the causative agent of purulent inflammation can be brought directly into the orbit by a wounding object. The initial foci can be boils on the nose and lips, boils and abscesses on the skin of the face, erysipelas of the face, eyelids, barley, purulent dacryocystitis, purulent processes in the paranasal sinuses, diseases of the dentition, general infectious diseases in cases of spread by metastatic pathways.The occurrence of phlegmon of the orbit is possible as a complication in the puncture of the maxillary sinus and the penetration of pus into the orbit. Among young children, the most common cause of phlegmon is osteomyelitis-related inflammation of the upper jaw. Here, the age characteristics of the anatomy of the teeth and jaws in children matter. Permanent teeth, the formation of which is not completed and milk teeth have a wide cavity, which freely communicates with the surrounding bone tissue. This is facilitated by the wide lumen and the large apical opening of the root canal.Intensive blood supply to the pulp of teeth and jaw bones in children, an abundance of collaterals of blood vessels, intensive lymph circulation creates conditions for the rapid spread of acute inflammation from the tooth cavity to the bone tissue, and then to other surrounding tissues. The causative agents of phlegmon of the orbit are more often golden and white staphylococci, hemolytic and greening streptococci, less often Friedlander’s pneumobacillus, Frenkel’s diplococcus, Escherichia coli. The disease develops suddenly and quickly, within 1-2 days, sometimes several hours, especially in cases of metastatic spread, with a very severe general reaction: fever, weakness, slow pulse, chills, headache, pain in the eye socket.Young children may also have nausea, vomiting, and loss of consciousness. The eyelids are swollen, infiltrated, dense, hot to the touch, the skin of the eyelids is hyperemic. Edema and hyperemia spreads to the area of ​​the root and back of the nose, the cheek, or the entire half of the face. There is also conjunctival chemosis, the edematous conjunctiva sometimes falls out of the conjunctival sac in the form of a roller and is impaired between the eyelids. There is an immobility of the eyeball. In the fundus, a picture of optic neuritis is more common, only mild congestion can be observed, or there may not be any pathology.Phlegmon of the orbit is differentiated from phlegmon of the infraorbital-zygomatic region, in which there is a pronounced edema of the facial tissues, which spreads to the upper lip, to the infraorbital region, then to the lower and even upper eyelid, zygomatic bone, the palpebral fissure narrows or closes due to eyelid edema. The infection spreads with phlegmon of the infraorbital-zygomatic region from the perianical morginal tissues of the canine or the upper first small molar, less often the periodontal tissues of the upper lateral incisor or the upper second small molar.With phlegmon of the orbit there is no “causal tooth”, the eyelids are so swollen that the palpebral fissure closes completely, exophthalmos, a sharp limitation of the mobility of the eyeball. There is conjunctival chemosis. They also differentiate with the phlegmon of the infratemporal and pterygopalatine fossa, but with the latter there is a sign of impaired motor function of the lower jaw, which is not the case with phlegmon of the orbit. There are pains radiating to the temporal region and eyes, aggravated by swallowing, exophthalmos can be observed. The phlegmon of the infratemporal and pterygopalatine fossa, in turn, is differentiated from the phlegmon of the temporal region, in which there is no exophthalmos when the pyoinflammatory process of the temporal region is localized in the subcutaneous tissue, there is hyperemia, swelling and infiltration of soft tissues that fills the entire temporal region.With the spread of hyperemia and edema forever, the process resembles a phlegmon of the orbit. With phlegmon of the cervical region, there is a pillow-like swelling of the buccal region, lower and upper eyelids, the palpebral fissure narrows or closes completely. The edema spreads to the lips, to the submandibular region. The inflammatory process can quickly spread to the cavernous sinus, cavernous sinus thrombosis, meningitis, brain abscess, or fatal sepsis occur. In the past, fatal outcomes were common in children.Now, thanks to the early use of sulfonamides and antibiotics, complications and death are rare. In children, phlegmon of the orbit occurs more often at the age of 7-9 years and up to 1 year of age and has its own age characteristics. In young children, general symptoms prevail, while in older children they are local. In newborns, the eye muscle is poorly developed and wide and consists mainly of the alveolar process with the follicles of the teeth located in it. The body of the jaw is insignificant, so the rudiments of milk teeth lie directly under the orbits.As the jaw grows, and it grows especially intensively in the first 5 years of life, the alveolar process recedes more and more from the orbit. With late or insufficient treatment, complications such as corneal ulcers, neuroparalytic keratitis, persistent ocular muscle paralysis and strabismus, ptosis, and rarely panophthalmitis can develop. Radiographically, diffuse darkening of the orbit is detected without changes in the bony walls and changes in the paranasal sinuses.

Treatment: the use of broad-spectrum antibiotics intramuscularly, intravenously, retrobulbar, intralumbar, as well as sulfonamides.In case of intervention in the upper eyelid area, incisions in the area of ​​the inner 2/3 of the orbital edge should be avoided to prevent postoperative ptosis. To create an outflow and reduce tissue tension, a wide opening of the orbital cavity with drainage is performed, intranasal surgery to sanitize the “causal sinuses”. In connection with headaches and pains in the depth of the orbit, analgesics, hypnotics, UHF orbital area and a warming compress are prescribed. To relieve perifocal edema, cocaine – adrenaline tamponade of the nasal mucosa (5% cocaine solution with 0.1% adrenaline solution).If there is congestion in the fundus, dehydration therapy. In early childhood, the use of gamma globulin, blood plasma transfusion is recommended. In all cases, vitamin therapy is required. Antibiotic therapy – penicillin intramuscularly and intravenously 150,000-200,000 U / kg body weight. Kefzol (1 g every 8 hours), antifungal drugs – nystatin, levorin 500,000 IU 3-4 times a day, amphotericin B 50,000 IU in 5% glucose solution, intravenous drip). As detoxification therapy, children use a glucose-vitamin mixture (500 ml of 5% glucose solution, 5 g of ascorbic acid, 10 U of insulin, 500 ml of Ringer-Locke’s solution, 400 ml of Hemodez.In severe cases, the total infusion for adults can reach up to 4 liters of fluid per day, at 2-3 years old up to 2 liters, at 3-5 years old up to 3 liters, older than 5 as for adults.

Diuresis is supported by the administration of lasix (at a dose of 40 mg, children at the rate of 0.1 mg per 1 year of life. IM or IV glucocorticosteroids 3-5 mg / kg. Anticoagulant therapy with daily monitoring of coagulogram is recommended daily. anticoagulant action Contracal is administered at 5000-10000 U / day, nicotinic acid at 2.5 mg / kg of body weight…. Trental is administered intravenously drip 100-200 mg. In the decompensated phase of hypercoagulation and the threat of thrombosis of massive sinuses, the administration of a direct anticoagulant – heparin 100-200 U / kg of body weight per day is shown. Recommended vit “A”, “C” and gr. “IN”. Adults are injected intramuscularly with 25-30 μg (0.5 ml 0.005% solution) 1 time in 4-5 days of prodigiosan, which stimulates the T-system of immunity, the function of the adrenal cortex contributes to the production of its own interferon. Only 3-6 injections. Children in smaller doses (10-20 mcg).Antistaphylococcal gamma globulin is injected daily at 500-300 IU (for a course of 3-5 injections) to provide passive immunity.

Fungal diseases of the orbit. When the walls of the orbit and its contents are infected with fungi, as well as when infected with microorganisms, inflammatory orbital diseases occur. Fungi penetrate into the orbit from the foci of the maxillofacial region (from the skin of the face, the accessory cavities of the nose, from the oral cavity, from the teeth, jaw bones, etc.), with injuries of the orbit and surgical interventions.Of the fungal diseases, actinomycosis of the orbit (actinomycosis orbitae) is more common. The disease is caused by a radiant fungus discovered by Israel (Israel) in 1878 in humans.

Studies have established that actinomycetes are found in the oral cavity as saprophytes. They are located on the mucous membrane of the mouth, crypts of the tonsils, periodontal pockets, carious dental cavities, in the contents of plaque and calculus. Aerobic actinomycetes also nest on the skin, in the digestive tract, and the conjunctival sac.The weakening of the body, vitamin deficiency, severe debilitating diseases create a favorable environment for the transformation of the fungus from a saprophyte into a pathogenic pathogen. In the mouth, at the site of the primary introduction of the fungus, a lumpy knot is formed, dense to the touch, which breaks out, forming a fistulous passage, through which a small amount of liquid pus is released, containing druses of the ray fungus, which have the appearance of yellowish-gray grains. The inflammatory process spreads to the cheeks, temporal region, infratemporal muscle, etc.e. Generalization of a process is extremely rare. Inflammation can occur in the form of an inflammatory granuloma, orbital cellulitis, and most often in the form of osteoperiostitis. Orbital actinomycosis is manifested by exophthalmos, limited mobility of the eyeball, atrophy of the optic nerve, and even an abscess with complete destruction of the eyeball. The defeat of the bone wall of the orbit is determined using a probe through the fistula, which is formed in all clinical forms of orbital actinomycosis. Finding druses allows for an accurate diagnosis.In doubtful cases, if druses are not found, an allergic skin reaction with actinolysate as an antigen helps to correctly diagnose. 0.3 ml of actinolysate is injected into the skin of the flexor surface of the forearm. If after 24 hours at the injection site there is a bright redness, swelling and a deep red nodule in the center, the reaction is considered positive. For diagnostic purposes, a complement binding reaction (Bordet-Zhangu reaction) with actinolysate as an antigen is also set. The course of the disease is slow and chronic.

Surgical treatment consists in opening the fistula, removing granulation masses, antiseptic tamponade of this area. Drug treatment – large doses of potassium iodide, often in combination with sulfonamides and antibiotics, fungicidal and fungistatic agents. X-ray therapy, a course of injections of actinolysate.

In sporotrichosis orbitae, a rare disease caused by the fungi sporotrichum, the pathogen is introduced into the orbit from the skin of the face, oral cavity, where it is constantly present as a saprophyte, or bones of the facial skull.It flows in the form of osteitis and periostitis of the orbital walls. The clinical picture is the same as in orbital actinomycosis. The inflammatory process ends with abscess formation and fistula formation. Through the latter, pus comes out.

A case is described when sporotrichosis proceeded in the eyelid in the form of a chalazion, then spread into orbit and ended in recovery only after exenteration of the orbit (II Merkulov, 1966). Even less common are fungal diseases such as blastomycosis orbitae and mukormicosis.

Tenonite. It is known that the eyeball is enveloped from the back and sides by a connective tissue capsule, which is formed from a system of fascia starting at the apex of the orbit, where they are tightly connected to the sheaths of the optic nerve and to the annulus fibrosus. These fascial bundles dress muscles, blood vessels, and nerves. At the equator, those bundles that cover the inner surface of the muscles leave them and curl over the eye, forming a tenon capsule. Fascial sheets covering the outer half of the muscles grow together with the sclera near the cornea, forming the anterior capsule.The gap between the eye and the tenon capsule is regarded as the lymphatic space, which is connected with the lymphatic and vascular pathways, and through the perivascular spaces of the vorticose veins – with the inner parts of the eyeball. These connections play a role in the spread of the pathological process. The cause of tenonitis can be general infections – influenza, rheumatic, inflammatory process in the eye, damage to the bursa, including during operations for strabismus, erysipelas.Tenonitis (tenonitis) develops sharply, often in one eye. Usually there is swelling of the eyelids and mucous membranes, exophthalmos, restriction of eye movements, pain during movement, and sometimes diplopia. Serous tenonitis flows more favorably and is easier to treat. When purulent, pus breaks out into the conjunctival sac. As a result of tenonitis, iridocyclitis may develop.

Treatment – thermal procedures (UHF therapy, diathermy, dry heat, subconjunctival and retrobulbar injections of cortisone with antibiotics for serous, resorption and dehydrating therapy, sulfonamides.With purulent – opening and drainage of the tenon capsule, antibiotics, and then local physiotherapeutic treatment.


Sarcoidosis is a multisystem granulomatous disease of unknown origin. Tuberculous epithelial cell granulomas that do not undergo necrosis develop both in the skin and in other organs. In sarcoidosis of the orbit, the clinical picture resembles a slowly growing tumor and is usually localized in the upper external part of the orbit.

Treatment – surgical – granuloma excision.

Wegener’s granulomatosis – with a lesion of the orbit, symptoms of a rapidly growing tumor of the orbit appear, a decrease in body weight and the diagnosis is established only after a pathological examination. With this systemic disease, destructive-productive vasculitis, polymorphic-cell granulomas occur. The vessels of the upper respiratory tract, chonic diffuse nephritis and diffuse angiitis are affected.

Pseudotumor is a term that unites a group of diseases based on nonspecific inflammatory changes in the tissues of the orbit.Depending on the localization of the inflammation focus, primary idiopathic myositis, local orbital vasculitis (the pathological focus is located in the orbital tissue) and dacryoadenitis (the lesion is localized in the lacrimal gland) are isolated (Brovkina A.F. 2002). The diagnosis is made after histological examination of the pathologically altered tissue obtained during diagnostic orbitotomy. These diseases are characterized by a sudden onset with symptoms resembling the manifestations of malignant tumors of the orbit, abscess.

Treatment: retrobulbar or parenteral corticosteroids, topical instillation of antibacterial drops, artificial tears. Autoimmune processes play an important role in the development of chronic inflammatory diseases.


There are benign and malignant tumors in the orbit. Tumors can develop primarily from the tissue, the wall of the orbit, from other parts of the organ of vision lying in the orbit: optic nerve, lacrimal gland, muscles, metastatically in malignant neoplasms of other organs, and can also spread from neighboring parts (malignant tumors of the upper jaw, frontal osteoma sinuses, retinal gliomas, choroid sarcomas, etc.etc.).

Benign tumors grow slowly, very quickly malignant ones. It is sometimes difficult to distinguish between primary and secondary tumors. In secondary tumors, significant visual impairment and fundus changes are combined with a relatively small exophthalmos. This is an important differential feature. An early symptom of orbital tumors is eyelid edema, paresthesia of the periorbital region and pain, often significant, radiating to adjacent areas. Then exophthalmos appears, limitation of mobility (mobility does not suffer when the tumor is localized in the area of ​​the muscle funnel), displacement of the eyeball, diplopia, visual acuity decreases, a central scotoma appears, or a narrowing of the visual field, in the fundus – congestive nipple, optic nerve atrophy, hemorrhages and retinal detachment.The listed symptoms are in various combinations, depending on the size, growth rate, location and nature of the tumor. Diagnosis of orbital tumors is one of the most difficult areas of ophthalmology. The methods of investigation are X-ray, in which one can note the thinning or destruction of the walls, an increase in the size and darkening of the affected orbit, computed tomography showing the presence of a tumor, localization and extent, orbitography based on radiological contrast of the orbit, venography, orbital thermography, carotid angiography, B – method of echography (scanning).With vascular lesions of the orbit and suspicion of a malignant tumor, the orbitography method is contraindicated. To determine the malignancy of a neoplasm, a radionucleide study with radioactive phosphorus – 32 P, iodine – 125 J and 131 J, strontium – 85 Sr, etc. is used. some benign neoplasms and pseudotumors of the orbit can accumulate an isotope, like malignant neoplasms

Determination of free sulfhydryl and disulfide groups in blood serum is used as a test for diagnosing a tumor and its nature.


Dermoid cysts (dermoidem cysticum). They develop from detached tissue rudiments of the embryonic dermis. Histological examination shows that the dermoids have a dense capsule, contain sweat and sebaceous glands, hair follicles and hair, epidermal scales. They are localized mainly in the upper corner of the orbit, in the area of ​​the bony sutures of the frontal process with the process of the upper jaw or zygomatic frontal suture and are always associated with the periosteum.Dermoid cysts also occur under the muscles of the floor of the mouth, under the tongue, in the tongue, and the root of the nose. A case is described where, along with the indicated content, the formation of teeth was noted, also originating from the ectodermal anlage. Dermoid cysts have an elastic soft consistency, are not adhered to the skin, and are more often observed in early childhood. They grow slowly, growth usually increases towards the end of the 1st year of life, both in adolescence and during pregnancy. There may be recurrences of the cysts and in these cases there may be their malignancy.With the growth of the tumor, exophthalmos with a displacement of the eyeball, limitation of mobility, and decreased visual acuity may appear. X-ray examination at the site of cyst formation may be a depression with even, clear, sometimes serrated edges, or a violation of the integrity of the bone wall of the orbit in the form of a through defect. It is necessary to differentiate dermoids with cerebral hernias. Treatment is prompt.

Cerebral and meningeal hernia (encephalocele, meningocele) – cystic formations localized in the upper-inner corner of the orbit between the frontal, lacrimal bones and the frontal process of the upper jaw or in the region of the bridge and the inner part of the brow arch, or between the frontal and ethmoid bones.Encephalocele is a protrusion of the brain with meninges, and Meningocele is a protrusion of the meninges with cerebrospinal fluid. Distinguish between anterior and posterior hernias. A cerebral hernia with anterior localization can be felt as an inactive soft tumor. May occupy the top of the seam. If it communicates with the cranial cavity, then you can see its pulsation, an increase in size when breathing, crying, coughing, straining, tilting the head, with pressure on the tumor. This does not happen with dermoids.A cerebral hernia should also be differentiated from a neonatal blood tumor, hemangioma, and a congenital cyst of the lower eyelid.

Treatment – operative and performed by a neurosurgeon.

Haemangioma is the most common congenital tumor of the orbit. A tumor can appear at any age, starting in early childhood. It occurs 2-3 times more often in girls. They grow slowly, but can grow rapidly in the first months and years of life. It occurs in the form of a simple angioma – a plexus of dilated veins, a cavernous, buried tumor, consisting of a network of cavities filled with fresh and coagulated blood, racemose and mixed.In the orbit, cavernous angioma is more often observed, which is often localized in the area of ​​the muscle funnel. With this localization, the eyeball is protruding straight ahead. With other localization, there is also a displacement of the eyeball. Exophthalmos grows slowly. In patients with cavernous angiomas, painful sensations are usually absent, the general condition does not suffer. In addition to all other signs of an orbital tumor, angioma is characterized by an increase and thickening of the tumor under the influence of tension, stagnation in the venous vessels of the head and repeated subconjunctival and subcutaneous hemorrhages.If you make a puncture, then in the case of an angioma, a certain amount of blood is sucked into the syringe. Orbital angiography is of great importance in diagnostics.

X-ray examination in the first period of neoplasm development shows a darkening of the affected orbit, then an increase in its size, thinning of its walls, usury, sometimes hyperostosis of the bone. The presence of thrombosed vessels in the orbit helps the diagnosis. The most accurate diagnosis is made by contrast-enhanced computed tomography and ultrasound scanning.

Surgical treatment. Short-focus radiotherapy is sometimes successful, especially for simple angiomas. Radiation therapy for angiomas up to one year of age. Cryotherapy and sclerotherapy are also used.

Osteoma of the orbit (Osteoma orbitae) is a secondary formation and in most cases comes from the accessory cavities. It grows slowly, during the growth period it remains asymptomatic for a long time. Localized in the inner parts of the orbit, very dense to the touch. The clinical picture, as with all orbital neoplasms, is exophthalmos, which develops slowly, displacement of the eyeball, limitation of its mobility, rarely diplopia, neuritis, congestive nipple and decreased vision.

The course of osteoma can be complicated by empyema of the paranasal sinus with the subsequent development of subperiosteal abscess, brain abscess, meningitis. Osteomas can grow from the sinuses not only into the orbit, but also into the intracranial cavity. X-ray examination is decisive in diagnostics. On radiographs, a clear shadow is determined, in intensity resembling bone tissue. The sizes of osteomas are different – from small, the size of a pea, where the use of computed tomography is better, to huge, occupying the corresponding sinus and the cavity of the orbit.

Surgical treatment with subsequent orbital plastics. Osteoma may be associated with mucocele.

Mucous cyst of the paranasal sinuses (Mucocele) – blockage of the mouth of the excretory duct of the paranasal sinus with an accumulation of mucous secretions. The secret has the appearance of a light, grayish-yellow opalescent amber, viscous, odorless mucus, it can be brown or coffee-chocolate in color in the presence of altered blood pigments. The chemical composition of mucus includes mucin, cholesterol and fat.In bacteriological examination, mucus is almost always sterile. Mucocele occurs more often in the frontal, less often in the ethmoid and maxillary sinuses. It grows slowly, there are no inflammations. Gradually increasing in volume, the tumor presses on the wall of the orbit, which atrophies partially or completely dissolves and the tumor is introduced into the orbital cavity. In advanced cases, when pressure is transmitted to the optic nerve, congestive changes in the fundus may appear. Exophthalmos and displacement of the eyeball develop.On radiographs, a stretched, affected sinus is clearly contoured, a displacement of its wall into the cavity of the orbit is noticeable, and sometimes the destruction of the wall. The transparency of the affected sinus does not change, only with suppuration it can be somewhat reduced. Tumor growth can be accelerated by trauma. The tumor is soft, elastic. If it is localized in the inner wall of the orbit, it resembles a stretched lacrimal sac. An atypical position of the cyst, freely passable lacrimal passages when flushing, and radiography or computed tomography of the orbit and paranasal sinuses help the differential diagnosis.Mucocele also differentiates with tumors of the orbit and paranasal sinuses, cerebral hernias and dermoid cysts. Until the cyst has gone beyond the adnexal cavity, it is asymptomatic. In the early stages, some swelling can be noted at the inner corner of the orbit or under the upper edge of the orbit, in its middle third. When probing a hernial protrusion, fluctuation is felt. Sometimes, long before the appearance of external symptoms of mucocele of the frontal cavity, patients complain of headaches.This happens in cases where the mucocele grows more towards the posterior wall of the frontal cavity and the frontal lobes of the brain. Computed tomography is decisive in the diagnosis, especially with mild clinical signs.

Neurofibroma of the orbit is a local manifestation of common suffering – neurofibromatosis (Recklinghausen’s disease). Diagnosis is not difficult if there are nodules along the peripheral nerves and coffee-with-milk pigment spots located on the skin of the abdomen, chest, back, which are a constant and characteristic sign of neurofibromatosis.Sometimes nodules are in the iris, in the sclera, in the cornea and even in the fundus, there may be glaucoma, elephantiasis, mental retardation.

Difficult to diagnose if only one symptom is present. If there is an isolated lesion of the orbit, then X-ray examination (computed tomography) gives a lot of value, in which changes of a hyperplastic (hyperostosis) or atrophic (deformation of the orbital bones or their destruction) character are detected. The orbit increases in volume, mainly in the vertical direction, the optic nerve canal expands unevenly, its walls usurize or collapse.With significant changes in the bony walls of the orbit, neighboring bones may be involved in the process. Orbital neurofibroma appears early. Signs of the disease are already noted at the birth of a child. It is believed that neurofibromatosis is caused by dysplasia of neuroectodermal tissue, the causes of which remain unclear.

Treatment – surgical. For complicated glaucoma – antiglaucomatous surgery.

Optic nerve gliomas. They belong to the primary tumors of the optic nerve and appear in the first years of a child’s life.Development takes place at the expense of glial tissue. In adults, there are meningiomas (endotheliomas), in which the tumor process occurs as a result of the proliferation of the epithelium of the hard and arachnoid membranes of the nerve. The leading symptom is the appearance of one-sided exophthalmos, which grows slowly, but can reach large sizes. In these cases, non-closure of the palpebral fissure, drying of the cornea, and the development of dystrophic processes in it are possible. In the case of intracranial localization of glioma, exophthalmos may not be present.

With glioma, visual acuity decreases from compression of the optic nerve fibers. There may be stagnant discs, massive hemorrhages, and retinal edema. The outcome of stagnation is optic atrophy. Ultrasound examination and computed x-ray tomography of the orbit allows detecting glioma in the early stages. Differentiate with angioma, cerebral hernias, Quincke’s edema, pulsating exophthalmos, hemorrhage.

Treatment – operative. operations are done in conjunction with neurosurgeons.


Malignant tumors of the orbit include: cancer and sarcoma. Sarcomas are primary malignant tumors of the orbit. They are found both in children under 10 years of age and in adults. It develops from any tissue of the orbit. Sarcomas can also spread to the orbit from the surrounding area. Clinical symptoms, the rate of tumor development, depend on the location of the tumor, its type. If the tumor is localized at the apex of the orbit, then first there is pain when the eyeball moves and a decrease in visual acuity due to compression of the optic nerve by the tumor, and only after a while exophthalmos appears.When localized in the anterior segment, edema of the eyelids appears, limitation of the mobility of the eyeball, then pain and a feeling of fullness in the orbit. Sarcoma growth is usually rapid. In children, rhabdomyosarcoma is extremely aggressive, the embryonic type develops in children under 5 years of age, and the alveolar type after 5 years (A.F. Brovkina 2002). The preferred localization of the tumor is the upper inner quadrant of the orbit with early involvement of the muscle that lifts the upper eyelid and upper rectus muscle, with the appearance of ptosis, limitation of the eye’s mobility, its displacement downward and inward.In adults, the tumor grows more slowly. Fibrosarcoma, which originates from the periorbitis, grows somewhat more slowly. The consistency of fibrosarcomas is dense, like cartilage, even bone. It affects patients in adulthood. Rarely gives metastases. It is similar in consistency and growth rate to osteosarcoma, which is almost always a secondary orbital neoplasm spreading from adjacent departments. In the place of its formation, it gives a bone defect, clearly visible on the roentgenogram. In the maxillary sinus, cancers and sarcomas predominate.Cancers with keratinization and adenosarcomas predominate.

Large cell sarcomas, spindle-shaped sarcomas, fibrosarcomas, chondrosarcomas, angiosarcomas. With neoplasms of maxillary swelling, the tumor in stage III goes beyond the walls of the sinus, penetrates into the orbit, the nasal cavity, destroys the hard palate. Gives metastases to the submandibular nodes and cervical. We must remember about the possibility of secondary tumors of the orbit. One of the alarming symptoms that allows one to suspect a swelling of the maxillary sinus is a possible headache, pain in the orbit, worsening at night.Tumors located on the upper, posterior and anterior walls of the maxillary sinus often cause neuralgia of the mandibular nerve. With the growth of the tumor towards the orbit, the contours of its lower wall are disrupted. The orbital margin becomes tuberous, dense. With the destruction of the lower wall of the orbit, a retraction of the eyeball is formed. From the maxillary sinus, tumors can move to the ethmoid labyrinth, and then grow into the orbit. In this case, the displacement of the eyeball is noted.

In sarcoma, the displacement begins earlier than in cancer.Exophthalmos with displacement of the eyeball causes diplopia.

When malignant tumors grow into the motor muscles of the eyeball, there is a limitation of its mobility and visual impairment. As a result of the spread of the tumor of the upper jaw into the orbit, edema of the eyelids may occur, which is explained by the compression of the pathways for the outflow of blood and lymph. Orbital cancer can develop initially and is usually between the ages of 26 and 27 and almost never occurs in children. Secondarily spreads from the eyelids, lacrimal sac, conjunctiva, paranasal sinuses.Orbital cancer can also occur as a metastasis in cancer of other organs (breast, uterus, liver, etc.). It grows more slowly than sarcoma, but the clinical picture is similar.

Treatment of primary malignant tumors of the orbit, surgical and radiation, with secondary radiation treatment.

In malignant neoplasms, complete or incomplete exenteration of the orbit is often used. If the tumor spreads to the paranasal sinuses, a combined operation is performed – exenteration of the orbit and sinuses.This operation can be performed by dental surgeons, therefore we describe the operation technique. Technique of the operation according to Golovin: two parallel horizontal incisions are made along the eyebrow and the lower orbital edge and perpendicular to them along the outer and inner edges of the orbit. The result is an H-shaped incision in which the affected eyelids are outlined with a double midline and the musculocutaneous flaps to close the cavity are indicated. The contents of the orbit are removed. The entire periosteum, together with the contents of the orbit, is separated with a raspatory, from the bony walls of the orbit to its very apex.Only in the area of ​​the upper and lower orbital fissures, where the periosteum is welded to the edges of these fissures and at the block of the superior oblique muscle, scissors are carefully used. Everything dressed with a periosteum, which has a conical shape, the contents of the orbit are pulled forward by hand or with tweezers, with strong scissors they cross the muscular-nervous bundle at the apex of the orbit and extract from the latter. They stop bleeding, remove suspicious tissue debris. The affected paranasal sinuses are opened, cleaned to healthy tissues.Sometimes almost the entire lower wall of the maxillary cavity, the nasal process of the upper jaw, the lacrimal bone, part of the nasal bone, the nasal process of the frontal bone, etc. are removed. Bleeding is stopped by tamponade, galvanic cauterization or diathermocoagulation. Then the skin flaps are pulled together with sutures. In the postoperative period, a loose tamponade of the cavity is used, the tampons are left for 3-4 days, then replaced with new ones. After 7-8 days, a course of radiation therapy is started. Later, ectoprosthetics are used. Of the complications during exenteration, bleeding, sometimes very severe, should be indicated.A blunt tamponade is recommended, the imposition of hemostatic forceps on the eye stump remaining at the apex, which sometimes has to be left for 1-2 days, cauterization of this stump. In case of very severe bleeding, they resort to ligation of the carotid artery. A more rare complication is damage to the walls of the orbit during the separation of the periosteum. Particularly dangerous is damage to the posterior half of the upper wall of the eye socket, tk. the dura mater is exposed, which can be injured and infected.


Echinococcus is the larval stage of the tapeworm – Echinococcus granulosis, and the cyst is the primary bladder with daughter vesicles. Echinococcus orbit (Echinococcus orbitae) is rare. In the eye socket, echinococcus is usually primary and develops from an embryo that has got here (oncosphere). Only very rarely is the penetration of an adult bladder from adjacent cavities (especially from the maxillary) due to the destruction of the bony walls of the orbit observed.Reverse penetration from the orbit into adjacent cavities is more common. The favorite localization of the orbital echinococcus is the outer-upper region of the orbit. The clinical picture of echinococcosis of the orbit is diverse and is determined by the intensity of the growth of the parasite, the duration of its stay and localization. It grows more often slowly, but there is also a stormy current. Sometimes it develops so quickly that a malignant tumor is suspected and the orbit is exenterated. With the growth of the cyst, edema of the eyelids, ptosis, hyperemia of the mucous membrane, exophthalmos with displacement of the eye, pain and muscle paralysis appear.Further, exophthalmos develops with ulceration and even perforation of the cornea. Then the eye is destroyed, phlegmon of the orbit and panophthalmitis can develop, with a breakthrough of the cyst into the brain – meningitis. Pain may appear before exophthalmos appears. Moderate at first, then very intense, tearing, boring, bringing the patient to a fainting state and depriving him of sleep. Pain depends on inflammation and mechanical compression of the surrounding tissues and nerves. Diagnosis is difficult, especially in the early stages, and rarely a diagnosis is made with certainty prior to surgery.To clarify the diagnosis, a Cazzoni reaction, a blood test, and an orbital X-ray are done. Differentiate with malignant and benign neoplasms of the orbit.

Surgical treatment. With timely surgery, satisfactory results are obtained.

Cysticercus of the orbit is observed more often at the age of 20-40 years and very rarely older than 40 years. Cysticercus is the juvenile stage of the tape parasite, its larval (finnose) stage, intermediate between the embryo (oncosphere) and the adult parasite (Taenia solium).Most often, cysticercosis affects the eye and brain, very rarely occurs in the orbit. The clinical picture is similar to the echinococcus of the orbit. Unlike echinococcus, cysticercus causes more violent inflammatory reactions. Differentiates with periostitis, phlegmon, echinococcus, serous cysts, benign and malignant tumors of the orbit.

Treatment – early operative.

Ascariasis is a widespread intestinal helminthiasis caused by the human roundworm, a large roundworm that parasitizes the small intestine.Small young roundworms can penetrate from the intestines into the stomach, then through the esophagus into the pharynx, respiratory tract, paranasal sinuses, into the eye area. Roundworms, trapped in the orbit, lead to the appearance of symptoms of a volumetric process in the orbit – these are axial or displaced exophthalmos, as well as signs of intermittent inflammation. The clinical picture of the disease depends on the number of parasites, the degree of sensitization of the host organism. There may be eyelid edema, conjunctival chemosis, keratitis, central retinal detachment and exudative chorioretinitis, often chronic blepharitis.This is due to an allergic reaction to metabolic products or the decay of helminths.

Combined treatment of ascariasis of the orbit – surgical and anthelminthic.


Damage to the organ of vision in diseases of the thyroid gland is quite common. At the heart of the pathological process in endocrine ophthalmopathy are changes in the outer eye muscles and orbital tissue, which occur against the background of the impaired function of the thyroid gland.At the same time, the degree and nature of thyroid lesions can be different (A.F. Brovkina 2002).

Three forms of the disease have been identified: thyrotoxic exophthalmos, edematous exophthalmos and endocrine myopathy, but the transition of thyrotoxic exophthalmos to edematous and further to endocrine myopathy is possible.

Thyrotoxic exophthalmos develops against the background of thyrotoxicosis and can be unilateral and bilateral. Typical for thyrotoxicosis is tachycardia, tremors, sudden weight loss, irritability and a feeling of fever.Due to retraction of the upper eyelid (due to spasm of the Mueller muscle, the palpebral fissure is widened, blinking is rare. Eye functions are not impaired. Computed tomography and magnetic resonance imaging do not detect changes in the soft tissues of the orbit. Symptoms can pass under the influence of drug treatment.

Edematous exophthalmos occurs more often in men aged 40-60 years and often after removal of the thyroid gland. The disease begins with partial intermittent ptosis, which occurs in the morning. Then there is a retraction of the upper eyelid, diplopia and exophthalmos, usually bilateral and rapidly increasing! It comes to subluxation and even dislocation of the eyeball.Chemosis of the conjunctiva can be so pronounced up to the prolapse of the conjunctiva from the palpebral fissure. Movement disorder begins with restriction of upward movement, then to the side and downward. In the process of decompensation, non-inflammatory edema of the periorbital tissues and an increase in intraocular pressure occur. At this time, a pronounced edema of the orbital tissue, cellular infiltration of extraocular muscles are morphologically detected. The sensitivity and trophism of the cornea is impaired, keratopathy and corneal ulcer, pain, lacrimation appear.On the fundus, you can see a picture of a stagnant disc with its subsequent atrophy. If treatment is not carried out, then after a year, retrobulbar edema ends with fibrosis of the orbital tissues. Complete immobility of the eyeball appears and, in connection with damage to the cornea and atrophy of the optic nerve, a significant decrease in its functions.

Endocrine myopathy begins against the background of hypothyroidism or euthyroid state with the appearance of diplopia, which is caused by a sharp shift to the side and limitation of its mobility.Exophthalmos develops gradually in both eyes. Computed tomography shows thickened and hardened external ocular muscles, more often the lower and internal rectus muscles. Other symptoms characteristic of edematous exophthalmos are absent. The stage of cellular infiltration is very short, but in addition to the thickening of one or two extraocular muscles, their density and fibrosis of the orbital tissues are revealed.

Treatment of causative, symptomatic and restorative endocrine ophthalmopathy (A.F. Brovkina 2002).

With subcompensation and decompensation of the process, corticosteroid therapy is prescribed. The daily dose in terms of prednisone is 40-80 mg / day. Steroid therapy can be combined with external orbital irradiation if the disease lasts 12-14 months. Symptomatic treatment is the appointment of antibacterial drops, artificial tears, sunglasses, and eye ointment at night. Reconstructive surgical treatment is performed if necessary.


  1. What are the symptoms of orbital diseases?
  2. What is purulent (ocular) osteoperiostitis?
  3. When do subperiosteal abscesses form?
  4. Name the reasons and define the phlegmon of the orbit?
  5. What should the phlegmon of the orbit be differentiated with?
  6. What is the most common orbital disease?
  7. What is orbital pseudotumor?
  8. What tumors are there in the orbit?
  9. What is the most common type of angioma in orbit?
  10. What is mucocele and why is this pathology described in ophthalmology?
  11. How to characterize orbital neurofibroma?
  12. What tumors does the orbital sarcoma belong to?
  13. What are the characteristics of early orbital tumors?
  14. What is the differentiation of the cystcercus of the orbit.
  15. What changes on the part of the organ of vision occur with edematous exophthalmos.

90,000 in the head, in the forehead, in the temples, inside the eye

Unpleasant sensations and pain in the head and eyes are familiar to everyone. This condition often indicates only the overwork of the visual analyzer, especially during prolonged work at the computer. Therefore, when the eyes hurt when the pupils move, and the person feels dry, as if sand had got into them, at the first stage it is necessary to give rest to the eyes (especially if you feel pain in the eyes when working at a computer or reading).However, if this does not help, then it is necessary to exclude pathological processes that are manifested by similar symptoms on the part of the visual analyzer. It could be:

  • 1. Increased intraocular pressure. In this case, the person most often feels that the eye hurts inside. This condition can be transient and accompany, for example, migraine or brain pathology, or it can be permanent and lead to gradual retinal detachment associated with glaucoma. In this case, the eyeball on palpation becomes stony density.
  • 2. Infectious diseases of the eyes, brain and intoxication. Inflammation of the mucous membrane of the eye – conjunctivitis – a common cause of pain when blinking and at rest. Pain in the eye socket that occurs when the eyes are moving suggests that the muscles of the eyes and nerves are involved in the inflammatory process. This situation can be observed both during intoxication with a banal flu or acute respiratory disease, and in such severe diseases as meningitis, encephalitis, etc. Inflammation of the paranasal sinuses (sinusitis or frontal sinusitis) can cause pain in the nose and eyes.With the development of complicated forms of these diseases, pus can penetrate into the cavity of the orbit.
  • 3. Trauma to the eyeball, head and facial skull can cause pain in the sockets and eyes. The reason is the direct mechanical impact or the ingress of foreign objects into the visual analyzer. A concussion can also cause pain in the forehead or temple when moving the eyes.
  • 4. Diseases of the eye appendages.A number of diseases can lead not to eye problems, but to inflammation of the lacrimal glands (dacryocystitis) or eyelids (meibeitis).

What should I do if my head hurts when I move my eyes?

Headache when moving the eyes and at rest (whether it is pain in the eyes when reading or working on a computer) is an extremely unpleasant condition for a person. Therefore, it is urgent to take an anesthetic drug of the group of non-steroidal anti-inflammatory drugs. The next step in helping a person is to see a doctor.If there are signs of a general infectious disease (influenza, acute respiratory infections), then a general practitioner will be able to provide adequate medical care. In other cases, it is necessary to consult an ophthalmologist and often a neurologist. If the cause of pain in the eye is the ingress of a foreign object or injury, in no case should you rub your eyes and try to reach such an object directly with your fingers. Eyes should be rinsed with plenty of clean water. If this does not work, urgently seek medical help.

Treatment of eye movement disorders

There are many reasons why the eyes hurt and there is a violation of their movement.However, this combination of symptoms indicates a severe pathology, where self-medication is inappropriate. Disorders of eye movements occur most often due to neurological pathology (diseases of the cranial nerves or circulatory disorders in the brain). An infectious process in the orbit can lead to a temporary disruption of movement and a condition when the muscles of the eyes hurt when moving up (most often this symptomatology is observed with inflammation in the lower fornix of the orbit). Treatment of eye movement disorders can only be carried out by an ophthalmologist in joint consultation with related specialists (neurologists, neurosurgeons).If the pain in the eye when moving the eyeball haunts you, seek help from the clinic “Neuro-Med”. Our experts will advise you in detail on all issues, as well as prescribe a suitable treatment.

90,000 Scientists have named three additional symptoms of coronavirus There are a number of additional symptoms that are found when a virus spreads.

In a study published Sunday on the Lancet, headache was identified as a symptom of the disease. The study found that eight percent of patients with COVID-19 in Wuhan, where the outbreak began, complained of headaches that tormented them in the first days after infection.

Ill patients reported onset of dizziness. Frequent attacks of dizziness or very severe or violent attacks of dizziness may indicate a more serious health risk, the Cleveland Clinic clarified, commenting on these cases.

Another lesser known, but clear alarming signal is a sharp loss of smell, noted scientists of the British Rhinological Society. There is already strong evidence in South Korea, China and Italy that a significant number of patients with proven COVID-19 infection have lost their sense of smell, the researchers explained. What’s more, in Germany, more than two-thirds of people with coronavirus reported an inability to pick up and recognize odors.

Finally, scientists have identified a general feeling of malaise and resulting confusion as potential signs of illness.In a recent report on the situation at a nursing home in Washington, where nearly a third of older people tested positive for coronavirus but half showed no signs of illness, infected patients complained of malaise, general discomfort and anxiety gripping them.

The Center for Disease Control and Prevention (CDC) has already named confusion as an urgent COVID-19 “warning signal”.

This information, the researchers note, suggests that people need to be vigilant during a pandemic and not succumb to complacency just because they do not have a fever and cough.

Remove trapezius muscle syndrome using manual therapy in Moscow

Trapezius muscle syndrome

Trapezius muscle pain is not always limited to just the area of ​​the muscle. For example, this muscle can cause pain in the ear, eye or lower teeth, and it is also a common cause of headaches. Moreover, all these pains are felt not as radiating from the back to the head or teeth, but as a completely independent toothache or headache. And, in general, the trapezius muscle is perhaps the most frequent source of pain in our body.This is due to the fact that the muscle performs many different functions and is often overloaded.

Overwork and overload open the way for illness. It was found that pain in the trapezius muscle is due to trigger points. According to Travell and Simons, the authors of the book on myofascial syndrome, trigger points of the trapezius muscle are much more common than in other muscles [J. Travell and D. Simons Myofascial Pains and Dysfunctions. Volume I. S. 353].

But the cause of the pain of the trapezius muscle does not always lie only in the physical plane.This muscle, like no other, is influenced by emotional factors. However, we will talk about the psychosomatics of the trapezius muscle and myofascial syndrome just below, in the section “Symptoms …”, and now – anatomy.

Anatomy of the trapezius muscle

The anatomy of the trapezius muscle suggests that the muscle is indeed trapezoidal. To be precise, we have two trapezius muscles – the left and the right. Each, individually, has the shape of a triangle with its apex facing the shoulder joint, and its base facing the spine.Joining together at the spine, they form a trapezoid. Recall that a trapezoid is a quadrilateral with two sides parallel and the other two not. By the way, due to the fact that there are not one, but two muscles, situations are possible when the trapezius muscle hurts on the left, right, or on both sides.

The anatomy of the trapezius muscle involves dividing the muscle into three parts: upper, middle and lower. The upper part is usually called the trapezius muscle of the neck, and the middle and lower part is called the trapezius muscle of the back.But, let’s immediately clarify that this division is not official – for documents, but colloquial – for ease of use in speech. In general, the trapezius muscle is one of the largest muscles. Starting from the back of the head, it extends to the lower thoracic vertebra, while covering the shoulder girdle from above, it reaches the collarbone.

Functions of the trapezius muscle

The functions of the trapezius muscle provide movement and statics of the shoulder, scapula and neck. For example, we use this muscle when we want to straighten our shoulders and straighten our neck, or when we bring our shoulder blades together and throw our head back, or when we move our shoulders up and down and back and forth.While walking, we wave our arms, and the muscle works in dynamics, and if we are sitting at the computer – in static. And even when we just stand with our arms down, the muscle also works to provide an anti-gravity effect. By the way, precisely in order to relieve tension and unload the trapezius muscle, we, mechanically, fold our arms over our chest or put them in our pockets.

Speaking about the anti-gravity function of the trapezius muscle, it becomes clear why, while working at the table, you need to make sure that your elbows are not suspended, otherwise the weight of your arms will cause overload.And, if this repeats from day to day and continues for many hours, then the appearance of pain cannot be avoided. This – to the question of the cause of the pain of the trapezius muscle. The same can be said for driving – the elbows should not be weighed down.

The “cervical” function of the trapezius muscle provides turns and tilts of the head. Therefore, the screen of the monitor and TV should be located directly in front of us. This will also prevent the development of pain and pathology. And, by the way, the habit of holding the phone with your ear also causes pain in the trapezius muscle.

Symptoms of trapezius muscle syndrome

Symptoms of the trapezius muscle are mainly painful in nature, this is due to the fact that the trapezius muscle syndrome is myofascial in nature.

Myofascial syndrome of the trapezius muscle is a pathology in which small painful areas are formed in muscle tissue – trigger points. For a long time, they may not appear in any way, remaining in a latent state.But as soon as they are activated, pain immediately arises. An uncomfortable posture, sudden movement, overload, hunger, hypothermia or stress can become an activation factor. By the way, pain associated with stress and emotions is the psychosomatics of the trapezius muscle.

The mechanism of psychosomatic reactions is easier to understand with the example of animals. The turtle, in danger, pulls its head into the shell, and most others simply press their head into their shoulders. Thus, animals protect their most vulnerable place – the neck.To us, too, evolution has retained this biological reflex. It is he, in response to stress, that causes us to strain many muscles, but, first of all, the trapezius. It is easy to guess that in those people who are experiencing constant emotional stress, the psychosomatics of the trapezius muscle will only grow. But back to the trigger points.

We have already said that trigger points occur more often in the trapezius muscle than in others. At the same time, there is an amazing pattern.In 95% of cases, trigger points are localized exclusively in the upper part – in the trapezius muscle of the neck and only 5% – in the trapezius muscle of the back.

In addition, for the vast majority of people, points arise in the same places; and there are seven such places. These are the seven classic trigger points of the trapezius muscle. At the same time, some of them can cause pain only in the back and neck, while others – in addition to the back and neck – also cause headaches. But, let’s list all the symptoms of trapezius muscle syndrome.

Let’s start listing the symptoms of the trapezius muscle with the neck. After all, trapezius muscle syndrome is the main source of neck pain. Most often, the pain goes along the posterolateral surface and reaches the skull. From the neck, the pain can go to the temple and the side of the head, and can also be felt behind the orbit or spread to the back of the head. Myofascial syndrome of the trapezius muscle can also cause reflected pain in the auricle (but not deep in the ear), as well as reflex dizziness and vegetative-vascular crises.

The next symptom of the trapezius muscle is facial pain. Usually it is localized in the corner of the lower jaw, the area of ​​the chewing muscles and lower teeth. This syndrome is well known to dentists.

Often, pain from the trapezius muscle of the neck activates satellite trigger points located in other muscles in the neck. This causes a tension headache. In general, the activation of satellite points is very characteristic of the trapezius muscle. This most often occurs with the scalene muscles.And if the points in the levator scapula muscle and the belt muscle are activated, then the symptom of “motionless neck” arises, in which it is impossible to turn the head.

Talking about the trigger points of the trapezius muscle, you need to pay special attention to a very insidious point located below, between the spine and the shoulder blade. Its insidiousness lies in the fact that it is capable of causing the re-formation of trigger points at the top – in the trapezius muscle of the neck. This problem is often “stumbled” by inexperienced doctors.Having eliminated all the triggers in the neck and upper back, such a doctor cannot understand why the pain is not going away. And the reason, most often, is at this point.

Also, trapezius muscle syndrome is characterized by pain in the shoulder girdle and apex of the shoulder joint. And then, everything that presses on the shoulders causes special pain and inconvenience. This includes bra straps, heavy outerwear, a shoulder bag, etc. It should also be noted that in this area there is a point that causes discomfort like “goose bumps”.Another symptom of the trapezius muscle is burning pain in the interscapular region or along the vertebral edge of the scapula.

In general, I must say that many people sincerely do not understand why their trapezius muscle hurts. After all, in their opinion, there is no reason for this. To clarify this issue, it must be said that pain in the trapezius muscle is often a consequence of our habits. After all, what we consider to be a common habit turns out to be a chronic microtrauma.For example, with trapezius muscle syndrome, symptoms may appear due to the habit of holding the phone with your ear or sleeping on your stomach with your head turned in the same direction. By habitually placing our hands on the top of the steering wheel or accompanying our speech with active gestures, we also cause muscle overload. The same imperceptible overload forms the symptoms of the trapezius muscle due to the habit of constantly pushing back the hair from the forehead with a sharp movement of the head. And by propping up our chin with our hands, we overload the trapezius muscle of the back.In general, drop by drop – the water wears away the stone. Similarly, chronic microtrauma is insidious in its invisibility. By the way, this is what prevention is for – in order to eliminate the accumulated overloads in time.

Regarding statistical issues, it should be noted that the trapezius muscle on the left hurts more often than on the right. Although, if you follow the logic – it should be the other way around. After all, most people have a right hand. Therefore, it should hurt more often on the right. However, the fact remains.Most likely, the whole thing is in compensatory overload, which occurs in contrast to the working limb. This often happens – the compensating section is overloaded more than the main one. As for medicine, there is no difference – the trapezius muscle hurts on the right or on the left – the treatment methods are the same.

Trapezius muscle treatment

Treatment of the trapezius muscle can be divided into primary and secondary. The main one is soft manual therapy. It radically differs from the usual manual one not only in its softness and safety, but also in its higher efficiency.And this is not surprising, because 90% of mild manual therapy consists of muscle and fascial techniques.