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Lisa Lin, Wei Pan, Gui-Shuang Ying, Gil Binenbaum; Ocular Findings in Children with Headache. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5211.
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© ARVO (1962-2015); The Authors (2016-present)
Children with headache are commonly evaluated by ophthalmologists. We sought to determine the prevalence of ophthalmological findings that suggest an ocular cause for headache or occult neurological disease, among children with headache.
We conducted a single center, retrospective study of children less than age 18 years age with headache who underwent a complete ophthalmological examination, including refraction and fundus exam, at the Children’s Hospital of Philadelphia over a 4-year period. Established patients with known etiology of headache, such as hydrocephalus or idiopathic intracranial hypertension (IIH), were excluded. Primary outcome was prevalence of one or more findings that might indicate an ocular or occult neurological cause of headache, including glaucoma, uveitis, optic disc swelling, or possible asthenopia from strabismus or refractive issues. Headache characteristics and associated symptoms were evaluated as risk factors for ocular findings.
From 2,100 examined children, a sample of 594 children with headache were studied. Mean age 9.4 yrs (range 2-18); 262 (44%) had headache as a primary complaint, 332 (56%) as a secondary complaint. Eighty-five (14.3%, 95% CI 11.6-17.2%) children had one or more ocular findings that could cause headache or be indicative of intracranial disease: strabismus (39, 7%), refractive issue (36, 6%), optic disc swelling (15, 2.6%), newly diagnosed uveitis (2, 0.3%), and acutely-worsened aphakic glaucoma (1, 0.2%). 5 children with disc swelling had papilledema (1 brain tumor, 1 cerebritis, 3 IIH), of which 4 had nausea/vomiting (N/V); 10 pseudopapilledema. Refractive issues included large uncorrected refractive error, overly strong myopic glasses, and glasses with astigmatic axes incorrectly switched between eyes. Headache duration and frequency, photophobia, N/V, and visual aura/changes were not associated with increased risk of ocular findings, but N/V and shorter HA duration were associated with increased risk of disc swelling (p=0.009).
A full ophthalmologic examination, including cycloplegic refraction, is indicated in the diagnostic workup of children with headache, as one seventh of children have a treatable ocular cause or ocular sign of intracranial pathology. Complaints of N/V should raise concern, but generally the presence or absence of coincident visual, ocular, or systemic symptoms are not reliable predictors of ocular pathology.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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